The Roots of Ohios Opioid Epidemic And How UH Is Responding

UH Clinical Update - July 2018

By Cliff Megerian, MD, President, UH Physician Network

The opioid epidemic will continue to be the subject of news stories for the foreseeable future. Many of those stories will be about what is being done to turn it around.

But how did this epidemic grow exponentially over the last two decades?

What happened in Ohio offers some explanation.

You may have noticed that Ohio always ranks near the top – by some measures, even No. 1 – in the rankings of states with the highest number of opioid overdose deaths. In fact, Ohio was the first state in the country in which drug overdoses exceeded auto accidents as the top cause of injury deaths. Now, that is the case in most states.

A confluence of factors helped make Ohio a state in which opioid abuse became prevalent.

Those included:

• The prevalence of pain clinics that became pill mills, the first of which was started by a doctor in Portsmouth. The physicians he hired went on to start their own pill mills, which spread throughout the region and the state.
• Its geographic location, where the two interstates known as “Heroin Highways” to the rest of the country intersect.
• The fact that Ohio was directly targeted by a Mexican drug cartel that expanded its base from California to the Midwest to find more customers, using known addicts to help locate them, then selling heroin through an elaborately organized home delivery system. (Eighty percent of heroin users start by using pills.)

Of course the rise in opioid addiction in this country had other causes – among them the misconceptions that patients experiencing serious pain could not get addicted, that pain was the “Fifth Vital Sign” and must be treated to the greatest extent possible, and that the opioid drug known as OxyContin was not addictive – false information that came from representatives of the drug company selling it.

Those are some of the reasons we got here. Now, UH is one of the leaders in responding to the opioid crisis. Some of what we are doing includes:

• Our use of the OARRS system to find whether patients are getting controlled substances from other providers
• Complying with new regulatory and system requirements for prescribing
• Encouraging and taking a minimalist approach to prescribing
• Implementing a Quality Assurance Chart Review to assess providers’ prescribing practices

We also created the UH Pain Management Institute, which is led by Jeanne Lackamp, MD. Her message is that moving beyond opioid pain medications is crucial, and that there are alternatives for treating pain that can be highly effective. (Many can be found through a consult with the UH Connor Integrative Health Network.) She also encourages the use of other interventional pain therapies that are not addictive, such as NSAIDs. And for patients who are struggling with opioid addiction, we offer consults and treatment through the UH’s Addiction Medicine/Addiction Psychiatry departments. For more details on any of these, email Jeanne.Lackamp@UHhospitals.org.

Randy Jernejcic, MD, Vice President of UH Clinical Integration, is UH’s representative to the Northeast Ohio Opioid Consortium, consisting of five hospitals in the region, who are working together on other ways to attack the crisis. Under his leadership, all incoming residents have been trained about properly treating pain, including the use of the UH Provider Toolkit we have developed. Residents also have been educated on the new state guidelines on prescribing, as well as UH’s own approach and standards.

UH leaders are working on ways to help patients and our medical practices dispose of unused opioids. For more specific information and guidance, please contact Heidi.DelVecchio@UHhospitals.org.

Dr. Jernejcic notes that the Consortium is releasing a strategic plan based on the principles of education, harm reduction, treatment, prevention and data. The education will focus not just on prescribers, but on other clinicians including nurses and medical assistants who encounter patients in the Emergency Department, on hospital floors and at health centers. These clinicians interact closely with patients, so it is important they know what to look for in addiction cases.

UH is dealing with this substance abuse crisis in our community with the gravity it deserves, and with a priority of doing what we can to slow the growth of this public health issue.