September 28, 2017
The impact of drug addiction, particularly opioid use, on our nation’s health and our healthcare system is sobering. Nearly 150 Americans are dying each day from drug overdoses. Every 25 minutes a baby is born with symptoms of drug withdrawal. The U.S. rate of opioid-related emergency department visits skyrocketed over the past decade. These rates are having a profound effect on families, communities, healthcare providers, and healthcare facilities.
Opioids are a class of drugs that include heroin as well as prescription pain relievers, oxycodone, hydrocodone, codeine, morphine, fentanyl, and others. An estimated 2 million Americans are dependent on prescription pain relievers, and half-a-million have a substance use disorder involving heroin.
Houston is not immune from this terrible epidemic. Although we have not seen as much of an increase in opioid use as some other states, Texas had a 16 percent increase in opioid hospitalizations over the last 5 years. Dr. Jamie McCarthy, chair of the Department of Emergency Medicine, reports that the Memorial Hermann-Texas Medical Center and LBJ emergency departments are both seeing an increase in overdoses and IV drug abuse.
This map from the Agency for Healthcare Research and Quality reveals opioid-related hospital trends for each state. And the American Medical Association is maintaining a micro-site with the latest information on the crisis.
It might surprise you to know that in 2015, the leading cause of accidental deaths in this country became drug overdoses, with car fatalities second. There has been a lot in the news about an increase in maternal deaths, particularly in Texas. Data from the State Maternal Mortality and Morbidity Task Force suggest that drug overdose was the second most common cause of maternal death in Texas in 2012.
We need to ensure that physicians are trained to address this problem, and that hospitals are prepared to intervene in the long-term care of patients with substance abuse not simply in the acute care of those with an opioid overdose. A recent study from Yale School of Medicine reported that overdose patients who came to the emergency department and received the most aggressive interventions –acute medical care together with help arranging follow-up treatment, not just a brochure, were most likely to continue treatment. And it’s not just our hospital patients who need comprehensive treatment. We need to address this issue within our prison population. Addicts are often imprisoned, but unless they are properly treated, they will return to drugs and prison.
What are the solutions?
Maryland has the highest opioid hospitalization rates in the nation. Dr. Leana Wen, the commissioner of health for the city of Baltimore, has been on the forefront of combatting the epidemic. She issued a blanket prescription for the opioid antidote, naloxone, to all residents of Baltimore in 2015, which has been credited with saving the lives of more than 800 people. This also was done for the state of Texas in 2015 by Senate Bill 1462. And this year, all public schools in Montgomery County, Maryland, including elementary schools, will stock naloxone.
But treating an acute overdose is not enough. We need to improve physician training in the appropriate use of pain medications and also enhance training so that physicians can identify the signs and symptoms of drug addiction and provide timely referral to appropriate services. At the same time, we need to lobby for expanded addiction services. We also need to have a clear understanding of the complexity of this issue – a recent NY Times article reveals that insurance companies are limiting patients’ access to pain medications that are less addictive as they carry a higher price tag.
Fortunately, our nation’s attention is focused on fixing this growing problem. In fact, at the National Academy of Medicine’s Annual Meeting next month, the President’s Forum will center on the opioid epidemic and its impact on the health of the next generation and features Kathleen Sebelius, former Secretary of HHS; Scott Gottlieb, FDA commissioner; Charles Baker, the governor of Massachusetts, and Judge Steve Leifman, discussing the problem as well potential solutions. The National Academy of Medicine just issued a special report, “First do no harm—marshalling physician leadership to counter the opioid epidemic.”
What are we as an academic medical center in the nation’s fourth-largest city doing to combat this crisis?
Dr. Holly Holmes, associate professor of geriatric and palliative medicine, helped host a regional symposium on this topic earlier this year in coordination with the University of Houston College of Pharmacy. This educational event was a great opportunity for leading experts to share their knowledge and collaborate. This video gives a glimpse into the program.
For the last three years, Dr. Michael Weaver, professor of psychiatry and behavioral sciences, has offered an outpatient clinic for the treatment of opioid use disorder at UT Physicians Psychiatry clinic. He says there is no shortage of new patients these days, and that Houston is feeling the impact of the opioid epidemic like many other large cities.
One response to the opioid epidemic is to train more physicians in the specialty of Addiction Medicine, which was recognized as a new medical subspecialty by the American Board of Medical Specialties just last year. Dr. Weaver is the inaugural chair of the new sub-board for Addiction Medicine for the American Board of Preventive Medicine. Trainees from any primary specialty of medicine are eligible to apply for this new subspecialty.
On the research front, Dr. Margaret Wardle, assistant professor of psychiatry and behavioral sciences, is developing a new research program in the department’s Center for Neurobehavioral Research on Addiction, which will complement Dr. Weaver’s clinical program.
We must continue to do all we can to combat the terrible epidemic of drug abuse and misuse—attacking the problem through prevention efforts, through increased public awareness, through better education of physicians, through research, and with enhanced addiction services and care. I am comforted to know that McGovern Medical School’s experts in all three of our mission areas are working hard to address this important individual and public health issue for our community.