A Physician's Perspective on Opioid Abuse in Utah

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If today is an average day, one person in Utah will die of an opioid overdose. 

Utah has the seventh highest opioid death rate in the nation, which costs the state more than $237 million per year in added healthcare costs. The cost, however, isn’t only financial, but emotional, and social. 

Additional — and unquantifiable — costs come in the form of family disruption, criminal justice, and lost potential and productivity. Media reports on these events don’t include the reality that a death caused by an opioid overdose usually represents the end of a heart-rending, stormy, and painful path that leaves scars on family, friends, and communities. 
Prescription opioids are dangerous, and for far too long, we’ve consumed them and prescribed them without fully realizing their inherent risks. Troubling facts help us better understand the real scope of the opioid problem, including the fact that of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.

Unfortunately, only 10 percent of the people with opioid addictions receive treatment. In 2001, Utah had 130 licensed treatment sites; now there are more than 500. Without treatment, these individuals risk untimely death due to a substance-abuse disorder.

As a provider, I’ve often asked myself: “Where do these people get the prescription opioids that caused their death?” We know only 20 percent come from a physician prescription. This means the majority of deaths caused by opioid abuse originated from leftover, legally-obtained prescriptions. Friends or family either gave them away or sold them. There are too many unused narcotic tablets available for misuse or diversion, which leads to dependence. 

In Utah, we’re seeing alarming increases in prescribing rates of opioid pain medication. There was a 29.4 percent increase in the rate of opioids dispensed — the rate jumped from 686.4 per 1,000 people in 2002 to 888.5 in 2015. An estimated one out of five patients with non-cancer related diagnoses are prescribed opioids in a physician’s office. However, we now understand opioids aren’t the best course of treatment for many conditions, and the amounts prescribed far exceed the actual need of a patient. We need to substantially decrease the number of opioids prescribed. 
The scope of the problem is apparent, and so is the need to take action. Three years ago, Intermountain Healthcare implemented the Opioid Community Collaborative to attack this problem from a 360-degree approach, including:

  • Public awareness campaigns
  • Patient education materials
  • Provider education programs
  • Opioid-specific analytics
  • Increasing access to treatment
  • The promotion of naloxone (an overdose reversal medication)

The provider education arm of the collaborative is gathering prescribing data to give to practitioners. This data shows significant variation in prescribing habits within the same medical specialty. Intermountain Healthcare’s surgical services and musculoskeletal programs are gathering consumption data for specific procedures to guide clinicians in appropriate use and to avoid over-prescribing. All of our pharmacies have blue “take back” boxes to provide easy access for disposal of leftover opioids and other medications. A published document also provides instructions on how to prepare your medications for disposal. View the document HERE.

To help further educate physicians, patients, and the community about the risks and precautions of opioid therapy for chronic pain, Intermountain’s Pain Management Clinical Services recently published a video titled “Opioids for Chronic Pain Management.” The video is available online at intermountainhealthcare.org/painmanagement.

At Intermountain Healthcare, we’ll continue to gather and share provider and specialty-specific opioid prescribing data across our system. We will gain a greater perspective on the problem, both within our system and in the community. The data will also help us see how changing our practice patterns can reverse the trend, so on an average day in Utah, another person won’t become dependent from a prescription opioid, won’t need substance use disorder treatment, and won’t die from a prescription opioid overdose.