The Opioid Epidemic

January 24, 2018

The Basics

                Opioids are a class of very powerful pain killers developed from the opium poppy plant. They are also referred to as opiates or narcotics. There are a lot of drugs in this class including morphine, codeine, hydrocodone, oxycodone, meperidine, fentanyl, and more. They range from completely natural to partially natural to completely man made. They also vary greatly in their strength; for example, fentanyl is approximately 100 times as powerful as morphine. Most opioids are classified by the Drug Enforcement Agency as Schedule 2 drugs. Schedule 2 drugs are considered to have the highest risk of abuse of all prescription medication and this may lead to addiction. With the Schedule 2 classification there are many additional restrictions for their use.

                When used correctly, opioids can be a very useful tool for prescribers when treating severe pain. However, patients can still experience many of their adverse effects. The most common adverse reactions include drowsiness, constipation, nausea, and vomiting. The list of less common effects is very long but one in particular makes opioids very dangerous: respiratory depression. When taken in large doses or in combination with other medications that have similar effects, opioids can slow a patient’s breathing to the point of stopping.

The Problem

                When an opioid’s risk for abuse and addiction is combined with its risk for causing harm, a significant public health problem is created. Even using the drug appropriately can create a euphoria or “high.” Stopping an opioid can cause symptoms of withdrawal. This leads someone who is addicted to an opioid to be more likely to use more than prescribed. When a patient’s prescription is completed or their prescription runs out a patient is more likely to turn to illegal drugs. These may be street drugs, such as heroin, or illegally obtained prescription drugs. It is at that point that the risks for an overdose rise significantly.

The opioid epidemic has been well reported in national news. The problem as a whole is very complex and will not be fixed overnight. According to data from the Centers for Disease Control and Prevention deaths from an overdose involving opioids have risen 400% since 1999. Iowa has fortunately not been hit as hard as other states; we are ranked 5^th lowest in drug overdose deaths based on data from 2015. Despite not seeing as large an increase in abuse, we still need to take measures to prevent misuse, decrease risks of dependence, and protect our communities.

What JCHC is Doing

At Jefferson County Health Center, we have formed a committee to address the rising problems and risks of opioids. There is representation from every affected department including Administration, Emergency, JCHC Clinics, Professional Clinics, Ambulatory Care, Medical and Surgical, and Pharmacy. We began in 2017 by meeting weekly to get the project started and we continue to meet every two weeks. We have also joined together with 24 other Iowa healthcare facilities in the Iowa Healthcare Collaborative, to get feedback and information about what other communities are doing to manage the crisis.

Part of the process includes reviewing our current policies and procedures to ensure consistency throughout our organization. We will be implementing a Comfort Menu to provide alternative options that will ensure our patients on the Medical-Surgical unit are as comfortable as possible, while at the same time reducing the need and use of opioid pain relievers. Data is reported to our Quality and Safety Committee to track our progress and opioid usage. The Inpatient Pharmacist completes one on one expanded discharge education for patients who go home with a prescription for opioid medications. It is our goal at JCHC to maintain high-quality care including the provision of safe and appropriate opioid usage.