You’ve no doubt heard the term “healthcare heroes” used to describe hospital and healthcare workers throughout the COVID-19 pandemic for going above and beyond the excellent care they provided and continuing to do to this day. However, in a post-pandemic world, this remains a relevant and appropriate description. In addition to COVID-19, the country is still reeling from the effects of the opioid crisis—which reached epidemic proportions prior to the pandemic, increased during the pandemic, and will likely continue for years to come. Indeed, the sobering reality of the opioid epidemic further highlights the critical role healthcare professionals play in combatting opioid addiction. Thus, when COVID-19 moves out of the spotlight, healthcare professionals should still be characterized as the healthcare heroes they are.
The national behavioral health data we collected speaks volumes. Nearly 19% of American adults say they have used prescription opioids within the last year, and over half (51.9%) acknowledged substance abuse has negatively impacted their life or the life of someone they love. Meanwhile, the CDC reports that opioid-related deaths quadrupled from 1999 to 2019, and some of the steepest increases occurred from 2015 onward. During the pandemic’s surge in substance use, the CDC also found synthetic opioid overdose deaths increased by over 38%, with nearly half of reporting jurisdictions citing an increase in overdoses by over 50%. These findings beg the question, what are people doing to mitigate this healthcare crisis?
Scott Weiner, MD, MPH, FACEP, FAAEM, is among those dedicated to combatting the opioid epidemic. As an emergency physician at Boston’s Brigham and Women’s Hospital with over 100 published credits, Dr. Weiner began noticing a sharp increase in opioid overdoses within his practice which prompted him to conduct research on prescription opioid usage and overdoses among patients. In a joint study with the Massachusetts Department of Public Health, Dr. Weiner found that over one in 20 patients (5.5%) discharged from the ER after opioid overdose died within a year of the visit.
Further, a study funded by the National Institutes of Health found that three out of 1,000 patients with no prior opioid usage who were prescribed opioids experienced an opioid overdose later on. Additional research into other social determinants of health found the likelihood of opioid usage to be higher among people who struggle with substance use disorders. “[For] people really struggling with substance [use] and opioid use, in particular, their brain is totally hijacked…it’s unfortunate because it takes over their life, they may end up losing their job and their families—and it’s not their fault,” Dr. Weiner explained.
There are multiple steps Dr. Weiner recommends physicians take to combat opioid addiction—from furthering the practice of only prescribing opioids when absolutely necessary and in the least amount possible to expanding discharge support for patients with opioid use disorder. He also advises physicians to take action beyond the normal discharge instructions and checklists by providing patients with access to follow-up appointments, recovery coaches, and substance use navigators within organizations such as California Bridge. Ultimately, Dr. Weiner envisions these organizations moving forward with larger-scale plans for community and hospital partnerships to provide education and resources for managing opioid use.
California Bridge’s Director and co-investigator Aimee Moulin, MD, also has a background in emergency medicine. She is frustrated by what she sees as the passive treatment of substance use patients, describing it as akin to being a bystander to someone’s addiction.
“Reversing an overdose and bringing that person back, but then not having any tools to offer them on the back end…you want to be able to help, you want to be able to fix something,” Dr. Moulin said. From her observations treating patients in emergency rooms, she thinks the pre-conceived notion of substance use patients resisting treatment is strikingly inaccurate. Instead, Dr. Moulin believes the environment of an emergency department, where immediate action is taken, is the ideal place to offer opioid use treatment and begin the recovery process. That’s why California Bridge works to offer low-barrier support for opioid patients, including medical treatment and access to follow-up care, as well as to destigmatize opioid addiction as something common and treatable. The organization’s original goal was to partner with 32 hospitals in California—it has more than surpassed that and now works alongside 100 facilities with an eye on further expansion.
It’s important to be mindful of the fact that there are effective drugs available for opioid withdrawal and overdoses, namely, buprenorphine and methadone. To expand the availability of such treatment, UC Davis Health began an initiative to reduce the barriers for physicians to receive X Waivers, granting them authorization to administer buprenorphine to opioid patients. As part of its efforts, the health system also created a substance use intervention team to further physician administration of opioid treatment. While Dr. Weiner’s research showed a one-year mortality rate among opioid overdose patients, those numbers are cut in half when X Waivers are granted.
“Any step you can take to get people across that [X Waiver] finish line can really improve the number of people who are actually prescribing these medications for addiction treatment,” observed UC Davis Health Assistant Professor James Chenoweth, MD, MAS. Dr. Chenoweth credits Dr. Moulin for helping him connect his background in toxicology and emergency medicine to combat opioid addiction, and he characterizes his work with opioid patients as some of the most satisfying experiences in his practice. Like Dr. Moulin and California Bridge, he encourages healthcare professionals to remove the stigma associated with opioid addiction by understanding and emphasizing that it is a disease, and he points to the available treatments as an effective way to move forward in helping end the epidemic.
It is more than appropriate to refer to healthcare professionals all across the country as healthcare heroes for their continued dedication to helping mitigate the opioid epidemic, and at PRC, we look to support the work of these heroes with our PRC Community Pathways program. We provide an in-depth behavioral health survey to understand your patient population’s unique outlook surrounding mental health and substance use, including opioids, to uncover data-driven insights and offer action planning tools for optimal public health strategy creation and implementation. Contact us to begin the Community Pathways conversation for your community.
Sources and Further Resources
California Bridge Official Website
CDC: Overdose Deaths Accelerating During COVID-19
CDC: Understanding the Opioid Overdose Epidemic
Penn Medicine: All About the X Waiver
PRC’s National Health Survey Brief: Substance Abuse
UC Davis Health: ED initiated buprenorphine as a bridge to opioid recovery