The growing problem of opioid addiction has rightfully taken position as one of the top public health issues of our time. The latest reports estimate about 2.5 million Americans are addicted to opioids, and that every day we lose 115 people from overdoses. Philadelphia has been hit particularly hard: last year, one out of three adults used a prescription opioid and over 1,200 people died from a drug overdose, most of them from opioids. That’s a 33 percent increase in fatalities from the year before.
This is a mounting epidemic affecting people of all ages and backgrounds, and reversing its course will take a multi-pronged approach not only at the national, state, and city levels, but also among hospitals and providers who play a central role in these efforts.
Penn Medicine is taking critical, comprehensive steps across our hospitals, outpatient practices and classrooms to better protect and treat patients, educate our health care professionals and trainees, and share our experiences with others in our field.
It starts in the clinic. The overprescribing of opioids – giving patients too many, and often, for pain that can be controlled with over-the-counter remedies – since the 1990s has led to widespread misuse of prescription and non-prescription opioids across the nation. To curb utilization of these drugs within our patient population, we’ve harnessed technology to “nudge” prescribers across Penn Medicine to prescribe safely and judiciously, limiting new opioid prescriptions for most patients to no more than a five-day supply. This setting will help reduce the risk of dependence and addiction in patients and limit the number of pills in our communities.
Our clinicians and scientists are also working to find the best treatments to help patients cope with pain, from studies in the laboratory probing the biological underpinnings of pain to identifying alternative pain management techniques that help patients recover from surgery without the need for opiates. In our Orthopaedic and Rheumatology practices, we’ve seen a 16 percent decrease in opioid prescriptions thanks to the use of additional ways to manage pain, such as IV Tylenol, regional nerve blocks, and pain pumps. Our clinical care teams are educating patients on the importance of rest and elevation after surgery, and reinforcing the fact that some pain is normal after major surgery and that it’s not usually a sign of a complication.
We also need to make sure patients receive education on how addictive opioids are and to help ensure they don’t fall into the wrong hands. In line with the U.S. Centers of Disease Control and Prevention guidelines, patients prescribed opioids – for both acute and chronic pain – should receive an agreement for them to sign that outlines the risk and benefits and proper care of the drugs. We’ve also launched efforts to make it easy to dispose of unused drugs – for example, Penn Medicine Cherry Hill provides all patients with a pre-paid stamped envelope to mail back any unused medications for proper disposal.
Tackling this problem also means improving access to treatment for patients with opioid use disorder.
Thanks in large part to the efforts of Emergency Medicine physician and medical toxicologist Jeanmarie Perrone, MD, more patients identified with pain reliever or heroin addictions are being offered medication-assisted treatment, such as suboxone, an opioid replacement therapy, while in the hospital to lessen their withdrawal symptoms and create a smoother transition to addiction treatment. From the hospital, they are connected to our Center of Excellence at Penn Presbyterian to ensure they stay in treatment and receive follow-up care, including referrals to an outpatient facility. Dr. Perrone also helps amplify Penn Medicine’s expertise by sitting on Philadelphia Mayor Jim Kenney’s Opioid Task Force.
Another program, part of the Penn Center for Women’s Behavioral Wellness, is helping pregnant women struggling with addiction. In addition to routine OB/GYN care, the program provides home visits from a patient navigator – much like a community health worker – as well as help with barriers to health, such as transportation to and from appointments. It also offers mental health services, giving our patients the opportunity to see a therapist for an added layer of support. And, because stopping opioid use during pregnancy can harm the fetus, these patients receive buprenorphine, which helps wean them off their addictive substance and is far safer for their babies.
Penn clinicians also work in the community to help patients battling opioid addictions. Prevention Point Philadelphia is a prime example.
What began as a small, local non-profit in the 1990s has become a multi-service organization that treats and educates vulnerable patient populations with substance abuse problems. Today, Prevention Point, with leadership from Penn Presbyterian’s Brian Work, MD, is a national leader in harm reduction practice and education, including use of the drug naloxone to reverse opioid overdoses.
Data plays a big role too. We are working with our IT department on an opioid registry to help track the dose of opioids prescribed to patients to ensure it is appropriate and within clinical practice guideline limitations. And researchers, including Emergency Medicine clinicians M. Kit Delgado, MD, and Zachary Meisel, MD, continue to collect and analyze data from our electronic medical records to better understand and inform physician and patient behavior.
We are known as a leader in so many facets of health care, and our role in combating this growing crisis should be no different – our patients, their families, and communities across the region and nation are depending on it.