Opioid use disorder is mostly associated with non-medical use of prescribed opioids and a major public health problem in the United States; an epidemic that is likely attributable to a two-decade increase in advertising, prescription, dispensing, and utilization of prescription drugs, most of which was diverted for non-medical use (Mathis et al, 2018). In 2016, Illinois was the number two hot spot for Opioid-related overdose death rates at 15.30 and opioid pain reliever prescriptions at 60.00 per 100,000 however in 2018, Illinois reported the lowest rate since 2006, with Illinois providers writing 45.2 opioid prescriptions for every 100 people, compared to the overall U.S. rate of 51.4 prescriptions (National Institute of Drug Abuse, 2020). Despite being 4.1 percent lower in 2017, 67,367 people died due to drug overdose in 2018, with opioids accounting for 7 out of every 10 deaths in the United States. Compared to the national average, Illinois has an opioid associated with almost 8 out of 10 overdose deaths in 2018, leading to 2,169 deaths in total. There was a 12.4 percent increase in deaths caused by synthetic opioids such as fentanyl, reaching 1,568 deaths (National Institute of Drug Abuse, 2020).
An example of a primary preventive measure is primary prevention programs aimed at encouraging proper storage and discarding of prescribed medication. Records indicate that preparation and ongoing education will enhance health professionals’ results, such as awareness and skills (Mathis et al, 2018). Secondary prevention initiatives include prescription drug monitoring programs (PDMP) and diversion control. Having a direct connection to electronic health records for ease of use for an opioid prescription may lead to positive results such as decreased use of multiple clinicians and opioid prescribing, diversion, and overdose losses (Mathis et al, 2018). An abstinence and medication-assisted therapy is a tertiary intervention (MAT) and evidence shows that, among other beneficial effects, MAT has improved retention of therapy and reduced illicit opioid usage. When combined with pharmacological therapy, psychosocial treatments have also been shown to be effective in the treatment of drug use disorders (Mathis et al, 2018).
Prescription opioid abuse and illegal use have become an increasing public health concern around the world, with a significant rise in prevalence, morbidity, and mortality. Between 1999 and 2014, prescription opioid sales nearly quadrupled in the United States, despite little overall improvement in the recorded prevalence of pain (Kim et al,2017). An evidence-based approach to addressing providers’ opioid prescribing rates is for clinicians to analyze the medical background of their patients’-controlled substance prescriptions using state Prescription Drug Monitoring Program (PDMP) data and determine if an opioid dosage or inappropriate combinations for their patients puts them at high risk of overdose. Prescribers should always start low and track PDMP data from all medications every 3 months at the time of chronic opioid treatment initiation and on a frequent basis during opioid therapy for chronic pain (Dowell et al, 2016).
The epidemic of substance addiction is profoundly affecting Wisconsin. Since 2000, opioid deaths have increased by 300% in Wisconsin. Wisconsin has seen a 600% rise in deaths attributed to prescription opioids from 81 in 2000 to 568 deaths in 2016. Heroin death overdose has doubled from 28 in 2000 to 371 in 2016. Heroin-related overdose lives lost have doubled and Milwaukee County has the highest rates of opioid-related deaths and hospitalizations in Wisconsin counties (Initial plan Milwaukee, n.d). The following are the stakeholders and organizations tasked with solving the opioid epidemic in Milwaukee county: Milwaukee county EMS, Milwaukee county substance abuse prevention coalition, city-county opioid, heroin, and cocaine task force, youth organizations, faith-based organizations, government, media, schools, legal/justice systems, civic organizations, health Services, businesses, nonprofit, alcohol, and other drug prevention organizations, and community members (Initial plan Milwaukee, n.d).
Although working in a number of settings, my professional experience with the opioid epidemic is restricted. In my current environment, we do not dispense opioids for pain, but we must go to Wisconsin Prescription Drug Monitoring Program (PDMP) data to determine if a patient’s opioid dosage or unsafe combinations put them at high risk of an overdose before administering any controlled substance. I typically consider drugs like NSAIDs, antidepressants, muscle relaxants, and glucocorticoid steroids in combination with physical therapy for pain relief, and if that doesn’t work, I refer out of pain management. The benefits of nonopioid analgesic medications and nonpharmacologic analgesic approaches are becoming more evident in the acute perioperative environment and in the treatment of chronic pain (Paul, 2017).
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain–the United States, 2016. Journal of the American Medical Association, 315(15), 1624–1645. https://doi.org/10.1001/jama.2016.1464
Initial Plan Milwaukee (Nd). City-County Heroin, Opioid, and Cocaine Task Force. Retrieved May 25, 2021, from https://city.milwaukee.gov/ImageLibrary/Groups/ccCouncil/District-10-Murphy/PDFs/CCHOTCF05.02.2018.pdf
Kim, B., Nolan, S., & Ti, L. (2017). Addressing the prescription opioid crisis: Potential for hospital-based interventions? Drug and alcohol review, 36(2), 149–152. https://doi.org/10.1111/dar.12541
Mathis, S. M., Hagemeier, N., Hagaman, A., Dreyzehner, J., & Pack, R. P. (2018). A Dissemination and Implementation Science Approach to the Epidemic of Opioid Use Disorder in the United States. Current HIV/AIDS reports, 15(5), 359–370. https://doi.org/10.1007/s11904-018-0409-9
National Institute of Drug Abuse (2020). Illinois: Opioid-Involved Deaths and Related Harms. Retrieved on 2021, May 24 from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/illinois-opioid-involved-deaths-related-harms
Paul F. White (2017). What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain? Expert Opinion on Pharmacotherapy, Vol (18), 4, 329-333, DOI: 10.1080/14656566.2017.1289176