By Karen Gorby
Chief Executive Officer/Chief Nursing Officer, Angel Medical Center
This month holds a health-related recognition day that’s both poignant and highly relevant to our community. August 30 is National Opioid Misuse Prevention Day. It will prompt our awareness of the devastating effects of this cruel and seemingly unrelenting public health crisis. I also want you to know what Angel Medical Center (AMC) is doing to address opioid misuse and abuse in our community and to protect our neighbors.
According to the North Carolina Department of Health and Human Services (NCDHHS), a staggering 12,000-plus deaths in the state between 1999 and 2016 can be attributed to opioids. Sadly, our region is also profoundly affected by the crisis.
Opioids are common painkillers that most have heard of, like hydrocodone, oxycodone and methadone. People become addicted to these narcotics quickly and their paths to addiction vary greatly, though there are some patterns that exist. For example, one group at high risk for addiction are teens and student athletes, who have historically been prescribed oxycodone after a sports-related injury. Opioids have also been used frequently as a treatment after a common teen oral surgery: wisdom tooth extraction. Studies have shown that a combination of ibuprophen and naproxen are equally effective as opioid painkillers.
Opioid addiction is a slippery slope. The American Medical Association (AMA) reports that across America each day 7,000 patients received treatment in the emergency department for improper opioid use. They’re prescribed medications, but physicians were misinformed about their addictiveness when they began prescribing them. Many who became dependent did so accidentally; the addiction is powerful and alters the brain, but there is help out there such as behavioral therapy, medication and inpatient/outpatient treatment.
North Carolina has responded to spiraling opioid overdose deaths by penning and introducing the North Carolina Strengthen Opioid Misuse Prevention, or STOP bill. According to a June 29, 2017, brief published by the North Carolina Medical Board, it aims to “…reduce the supply of unused, misused and diverted opioids circulating in North Carolina, reduce ‘doctor shopping,’ and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing.” Some important specifications of the bill include:
- Set limitations on how many pills can be prescribed for patients dealing with injury (the limit is a five-day supply maximum) and postsurgery patients (a seven-day supply or less).
- Clinicians must use the North Carolina Controlled Substances Reporting System (NCCSRS), a database that stores information on every controlled substance prescription filled by all of the state’s outpatient pharmacies.
- Prescribers must examine each patient’s HCCSRS prescription history going back a full year before they prescribe a Schedule II or Schedule III opioid for the first time; they must also review the patient’s database history continually for the duration of the patient’s prescription period. Automatic refills are banned as well.
Though these measures help to stem addiction rates, we at AMC have also put protocols into place that impact our own communities’ addiction rates.
We talk to all surgical patients about the realities and risks of opioids. Our current approach is to use fewer narcotics during anesthesia, and we’ve instituted an entirely non-narcotic preoperative regime. We’re also using safe alternatives to opioids for when our patients return home.
Finally, we’re committed to educating the public about opioid misuse:
- Never share your medications with anyone else or take anyone else’s
- Overdose deaths are often accidental; victims dangerously mix painkillers with alcohol or take a larger dose than prescribed by their physician
- For planned surgeries, talk to your doctor about opioid alternatives for pain management
- Storing medications and safely disposing of them are key weapons in the war against opioids; hospital-issued medication lockboxes offer safe storage, while mixing crushed pills with coffee grounds or liquid soap renders them unusable
- We need to rethink the role of pain management in hospitals – it may be both impractical and unsafe for patients to expect to be completely pain-free at all times – we think that comfort should more often be the goal; other things can help with pain too, such as taking a walk or enjoying time with a friend
We all have a role to play in lowering the sobering opioid-related addiction rates and tragic death statistics. Whether you’re a patient, caregiver or concerned community member, becoming more aware of the risks opioids pose, talking to your doctor about whether your pain can be managed effectively by an alternative method, and employing safe storage and disposal practices will go a long way toward lowering the potential for developing an opioid dependence.
Karen S. Gorby, RN, MSN, MBA, CENP, FACHE, is Chief Executive Officer and Chief Nursing Officer of Angel Medical Center. Gorby is a Fellow of the American College of Healthcare Executives (ACHE). For nearly three decades, she has served hospitals and health systems in Ohio before assuming her role at Angel Medical Center. Gorby received her MSN from Saint Joseph’s College in Standish, Maine, and her MBA from Wright State University in Fairborn, Ohio.