Examining the U.S. Opioid Crisis: Part 2

lradick March 9, 2018
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In the first part of Examining the U.S. Opioid Crisis, two thought leaders, Surita Rao, MD, FASAM, associate professor, psychiatry, University of Connecticut School of Medicine/UConn Health, and Stephen M. Merz, FACHE, president and CEO, Maine Behavioral Healthcare, weighed in on the history of opioid abuse and contributing factors to the current epidemic. Here, Rao and Merz share information with ACHE’s Inside Congress on regional factors affecting opioid abuse, and unseen costs to healthcare and the population.

ACHE: Have any regions of the U.S. escaped the opioid crisis? Are there any key factors that seem to be driving this crisis more in one region of the U.S. over another?

 According to the Centers for Disease Control and Prevention’s monthly report, Vital Signs, the amount of opioids prescribed per person was three times in 2015 than what it was in 1999. Also of note is that the amount of opioids prescribed varied by county. Some characteristics of counties with higher opioid prescribing include:

  • Small cities or large towns
  • Higher percent of white residents
  • More dentists and primary care physicians
  • More people who are uninsured or unemployed
  • More people who have diabetes, arthritis or a disability

Rao expands on this information, saying, “Another way to understand this is to know that providers in the highest prescribing counties prescribed six times more opioids per person than the lowest prescribing counties in 2015. But a positive sign was that half of U.S. counties had a decrease in the amount of opioids (morphine milligram equivalents) prescribed per person from 2010 to 2015.”

SOURCE: CDC Vital Signs, July 2017

Rao also points out that premature mortality due to preventable deaths, such as those that result from suicide, opioid and other drug overdoses, and heart and lung disease, is the highest among white, middle-aged patients in rural areas with low education levels and high levels of reported stress and worry. Forty percent of all drug overdose deaths are among people aged 45 to 64. These deaths occur most frequently in the heartland “opioid belt states” such as the Dakotas, Wyoming, Montana, Idaho, Wisconsin, Missouri, West Virginia and Kentucky, according to a study published in the journal Pharmacoepidemiology and Drug Safety in 2014.

“I do not recall any area of our nation being spared from the ravages of this epidemic,” adds Merz. “Many have speculated that generally higher rates of opioid use in New England and Appalachian regions may be linked to prescribing rates of pain killing medications, typically opiates (See map below). Others have speculated about the social and societal determinants of regional “spikes” in certain areas … strength of the economy, access to jobs and work for younger members of society and [a] significant workforce in natural resources, farming and related industries (e.g., fishing, lumber and construction) and the resulting increase in number of prescriptions for pain killers.”  

SOURCE: Maine Behavioral Healthcare

ACHE: The costs of opioid addiction place significant burden upon individuals, families and communities. What is one cost that is most overlooked or missed by healthcare providers and/or policymakers?

Merz points to the generational impact on our society. “We are literally losing a generation of people in our country who suffer with addiction and who are raising another generation of children with addiction, particularly in the case of those born with neonatal abstinence syndrome,” he says.

Rao agrees. “A patient population that may be relatively overlooked in terms of human and economic costs is pregnant mothers and their babies, born physically dependent on opiates they were exposed to in utero,” Rao shares, adding, “The costs are both human and economic, immediate and downstream, to the healthcare system.” In the United States, an estimated 14.4 percent of pregnant women are prescribed an opioid during their pregnancy, according to a presentation delivered in 2014 by Nora D. Volkow, MD, on behalf of the National Institute on Drug Abuse, to the Senate Caucus on International Narcotics Control.


Coming up at the ACHE Congress on Healthcare Leadership, Rao and Merz will be joined by Richard S. Schottenfeld, MD, chair, Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, for the Wednesday Hot Topic Session 2, “Opioid Misuse and Addiction: A Contemporary American Tragedy.

These industry experts will explore more deeply the origins, extent and nature of our current opioid epidemic and the driving factors behind dependence and addiction. They also will share their perspectives on the staggering and real costs of opioid addiction, how the healthcare field inadvertently contributed to it and the key role organizations can play in reversing it. Registration for Congress is still open! Register here.

Category: Q&A, Thought Leadership
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