The opioid crisis remains critical challenge for healthcare professionals. Learn how Health IT can aid in finding a solution.
How to Use Health IT to Fight the Opioid Addiction Crisis
More than 75 million Americans experience moderate to severe pain every year, with 50 million experiencing chronic pain and 25 million experiencing acute pain. As a whole, pain is listed as the third leading cause of sick days, costing Americans millions in lost wages each year. To handle this pain and get back to living their lives, many turn to prescription painkillers. However, while these painkillers can provide substantial relief, their addictive nature can take as much of a toll on a person as pain itself.
Many people get addicted to painkillers after receiving a prescription for a legitimate reason. Though the numbers are difficult to track, many experts estimate that eight and a half million Americans abuse their prescribed painkillers. The worst part about it? Many start young. About eight percent of high school seniors reported using hydrocodone for nonmedical reasons over the past year.
This painkiller abuse can devolve into full blown opiate addiction very quickly, an epidemic that affects millions and kills tens of thousands of Americans every year. Many even turn to heroin when their prescriptions run dry or get too expensive. Four in five recovering heroin users reported that their abuse began after becoming addicted to painkillers.
So how do we move forward and start fixing this problem? To help understand how to combat the growing opioid crisis, we’ve outlined the causes and effects of opioid addiction, the steps taken across the country to combat the problem and the role of health IT in the opioid crisis.
The Opioid Crisis
Many are calling the opioid epidemic the worst drug crisis in American history, with heroin and other opioids killing almost 30,000 people a year. Now, drug overdoses kill 40 percent more people than car crashes, and the number of people killed by opioids is still on the rise.
The opioid problem has been on a steady rise since the 1990’s, when opioids became more commonly prescribed among pain sufferers. Back then, the opioid problem was much less pronounced than the problems caused by cocaine. By 2014, however, prescription opioids caused 78.6 percent more deaths than heroin, 137.7 percent more deaths than benzodiazepines, which are sleeping and anxiety drugs, and 248.9 percent more deaths than cocaine.
The Causes of the Opioid Crisis
So how did we get here? What caused all of these addictions?
Many point the finger at the substantial increase in the prescription and use of prescription painkillers. In 1991, about 76 million prescriptions for painkillers were written, a number which nearly tripled to 219 million by 2011. These painkillers have the same effect on the brain systems as heroin, so when drug cartels began importing the cheaper, more potent heroin into the United States, many financially burdened painkiller abusers switched to the cheaper and more accessible option.
At the latest estimate, four in five new heroin users started out their addiction by misusing prescription painkillers, and 94 percent of surveyed people recovering from opioid addiction stated that they chose to use heroin because heroin was cheaper and easier to obtain than their prescription opioids. As a result, between 2005 and 2009 alone, the production of Mexican heroin experienced a six-fold increase.
It’s hard to say whether the demand for opioids prompted the influx of heroin, or if the supply of heroin upped the demand, but it all resulted in a dramatic increase in heroin abuse. With an increase in usage, however, came an increase in overdoses. Today, people of all ages and races are dying by the thousands every year, with people of Caucasian and Native American descent dying at double to triple the rates of African-American and Latinos. Young people tend to fall prey to heroin, while older individuals tend to become dependent on opioid painkillers.
The Basics of Opioid Addiction
Opioids include legal drugs like hydrocodone, codeine, morphine, fentanyl and others, as well as the illegal drug heroin. Legal opioids are mostly prescribed for the treatment of pain. These opioids attach to proteins in the body called opioid receptors, which are found throughout the body, and have the effect of reducing the person’s perception of pain. Side effects of these opioids include drowsiness, mental confusion, nausea, constipation and a sense of pleasure — due to the drugs’ affect on the brain regions involved with reward.
Normally, your body will react to pain by producing its own opioid chemicals, like endorphins and encephalins, but these are not nearly as strong as opioid drugs. Repeated use of opioid drugs, both prescription and illegal heroin, results in the body inhibiting the production of its own opioids as time goes on. This means if someone were to discontinue the use of their opioids, they would experience heightened pain and discomfort. This further encourages current users to keep using in an effort to avoid pain.
Another aspect of opioid addiction and death is the tendency to induce tolerance. This is when the person using the opioid no longer responds to the drug as strongly as they did before, causing them to seek out a higher dose to produce to the same effect. This tolerance is caused by the brain’s opioid system becoming less responsive over time. As a result of this, former users returning to the drug after a period of abstinence may accidentally overdose by using the dose they had used before quitting. By abstaining for a period of time, their tolerance to the drug ebbs away, meaning that a high dose will be more likely to cause an overdose.
The Effects of the Opioid Crisis
The effects of the opioid crisis don’t stop at unintentional overdose deaths, however.
Beyond the basic addictive behaviors exhibited by dependent individuals, opioid abusers also tend to experience numerous physical and psychological changes because of their addiction. Slowed breathing among opioid abusers has a long-term effect on the amount of oxygen that reaches the brain, resulting in hypoxia. This hypoxia can result in psychological and neurological damage, or even a coma.
Additionally, opioid use can reduce the amount of white matter in a user’s brain, which can negatively impact decision-making abilities, stress responses and behavioral regulation. Long-term users can also experience serious lethargy and paranoia, as well as liver damage and chronic nausea.
The use of opioids during pregnancy is also a substantial problem on the rise in the United States. Opioid use during pregnancy can result in numerous problems in newborns, referred to in whole as neonatal abstinence syndrome, or NAS. The cases of NAS in newborns jumped almost 300 percent between 2000 and 2009, driven mostly by the increased rate of opioid prescriptions given to pregnant woman. Today, 14.4 percent of pregnant women are prescribed an opioid at some point during their pregnancy.
Opioid addiction is also a burden on the health care industry, for multiple reasons. At a financial level, some estimates place the use of nonmedical opioids at a $72.5 billion annual cost to healthcare insurance companies. Stress on the healthcare industry itself due to opiate-related accidents is also a major factor — for instance, between 2001 and 2011, the number of fatal car accidents involving opioids tripled. This is primarily due to the reduced reaction time people experience while under the influence of opiates.
The use of needles for injecting opiates intravenously is also a significant issue. Many people share needles as a way to cut costs, but it increases the possibility of transferring blood-borne diseases. For example, HIV, hepatitis and a variety of other STIs are serious results of this behavior, and they can be life-threatening. Injecting opiates improperly can also be a problem, even if the needles are clean. Injecting powder into the bloodstream can cause serious infections, as well as long-term heart problems.
Finally, the behavioral effects and strains of opiate addiction on a person’s social life can be devastating. Many people will lose their jobs, either by skipping work repeatedly or by being caught violating work drug policies. This can result in severe financial stress, causing many to turn to crime to pay for their addiction. These factors, as well as the paranoia and anxiety caused by opiate addiction, can also place stress on one’s relationships and social life.
What to Do About the Opioid Crisis
Doctors, government officials and addiction specialists are struggling to come up with an answer to the opioid epidemic hitting the nation. Many efforts are directed at the treatment of addiction, including the following steps:
· Expanded access to naloxone: Naloxone is an antidote for opioid overdose, and it has reversed more than 10,000 overdose cases between 1996 and 2010. Until recently, naloxone was only available in an injectable form and was only carried by medical emergency personnel. Now, several states have expanded access for the antidote so that it is now available over-the-counter at local pharmacies. This new form is a hand-held auto-injector designed to be used by family members and caregivers as an immediate response to an overdose. Efforts are also being put into a nasal spray for even easier use.
· Expanded access to buprenorphine: The addiction medication buprenorphine was just recently allowed to increase in supply. This move by the Department of Health and Human Services means that the medication can be legally prescribed by doctors in larger amounts.
· Expanded treatment plans and facilities: Drug treatment facilities and rehabilitation centers are popping up across the country, both as individual buildings and as wings of hospitals, employing addiction specialists with training in the identification and treatment of opiate addiction.
Increased access to these drugs, as well as an expansion of recovery programs can have a positive effect on the rate of opioid addiction recovery. However, prevention of addiction should also be a primary focus. Some of the preventative measures currently in use include the following:
· Tighter prescription regulations: Much of the opioid addiction epidemic has to do with lax protocol in prescribing opiate painkillers. In twelve states, there are more prescriptions than people — Alabama and Tennessee both have 143 prescriptions per 100 adults in the state. Many medical and governing entities are looking into ways to normalize and regulate prescription practices in order to reduce painkiller abuse.
· Emphasize proper consumption methods: Opioid medications are specifically designed to behave a certain way in the body. Some are designed to be extended-release drugs for long-lasting pain relief, made to release slowly and steadily into the bloodstream after oral consumption. These pills will typically have a higher dose of opiates, so if such a pill were to be crushed and snorted, smoked or injected, the effect would be much stronger, potentially leading to an overdose.
If an individual is prescribed an opioid painkiller, it’s crucial to emphasize the importance of taking the medication properly, so as to avoid negative effects. Much of this has to do with the next point: education.
· Proper education: Curbing the abuse of prescription medications is a huge component of addiction prevention. This education must extend not only to patients, but to doctors and medical staff as well, so that addiction or potential for addiction can be identified as early as possible.
· Detailed electronic records: While health IT and the opioid addiction crisis may not seem to go together, electronic records can be a major boon to the healthcare industry’s efforts against opioid abuse. Keeping detailed records of a patient’s history is key in identifying patients with a history of substance abuse. This is especially important when trying to identify “doctor-shoppers” — or people who go from doctor to doctor to find one who would be willing to prescribe an opioid painkiller. These EHR records can be a key part in identifying addicts and encouraging them to get help.
The Importance of Health IT in the Opioid Crisis
Among the above preventative measures for opioid addiction is the use of detailed electronic records. Many hospitals across the country are now using such systems within their daily practices, tracking prescriptions and patient data. You may be wondering how a behavioral health EHR system can help prevent opioid addiction. To help you understand, here are a few of the numerous benefits of these systems:
· Easier tracking: Information can be easily collected and entered into the system, with prompts for admitting nurses to enter required information. This ensures all of the proper information is taken and stored. It also eliminates the need to enter data multiple times through the treatment process — data is taken once and then copied onto the necessary paperwork electronically, saving time and reducing the possibility of error.
· Improved organization: Information about patients can easily be found within an electronic system. Rather than flipping through piles of paper for what is needed, advanced searching tools or date-organized files can be used instead.
· Better medication management: Quality electronic health record systems may also include modules for tracking and prescribing medications. Compared to paper or fax prescriptions, electronic prescriptions make the process faster and easier, ensuring transcription accuracy and conserving time and resources.
· Fairer prescription practices: Before EHRs became more of a factor in the identification of addicts, identifying an addict was a relatively subjective process. Prescribing doctors would listen for key words and phrases to suggest that a patient might be an addict. However, this is not a definitive method for keeping out addicts — non-addicted patients with real pain management needs can sound very much like addicts when they are desperate enough for relief, and drug users can often hide their addictions well if they have enough practice under their belt. By using an EHR program in combination with these methods, doctors can more accurately determine needful patients from addicts needing help.
The benefits of behavior health EHR systems in combating opioid addiction have been substantial. Many organizations have seen a real effect on the number of patients receiving controlled substances on an annual basis. For example, in the state of Washington, the number of patients receiving prescriptions for controlled substances from multiple doctors fell by 25 percent between 2012 and 2014.
Where to Find a Behavior Health EHR System
If your substance abuse treatment organization is looking to implement a new electronic health records system to help combat addiction in your region, PsyTech Solutions can help. We offer advanced EHR software specifically designed for addiction treatment organizations, including our affordable and user-friendly Epitomax® software solution. We will work with your staff to create smart forms and workflows you can access from any web-enabled device or tablet, making it easy to keep track of everything on the go.
We offer all the benefits of a fully-fledged EHR software, including expedited data entry, medication management and HIPAA-compliant security. We’re even compliant with the 42 CFR Part 2 standards regarding drug and alcohol treatment confidentiality!
To learn more about Epitomax® software and determine if it is right for your substance abuse treatment or mental health treatment group, contact us to schedule a demonstration! A knowledgeable PsyTech Solutions representative will answer all of your questions about the software and show you all of the incredible software features your organization could benefit from.
Contact us now to schedule your demo!