Using New Tools in the Battle Against Opioid Misuse and Abuse

It might not lead the news every day, but deaths from opiate overdoses are higher than they have ever been.

‌This epidemic continues to grow – and the CDC’s database on unintentional overdoses puts Ohio sixth in the country when it comes to opioid-related overdose deaths.

There is some heartening news too, though, because of the increase in methods that UH and other healthcare providers are using to mitigate the misuse and overuse of opioids.‌

‌Here are some ways we work to reduce harm - beyond the walls of our system and deeper into our communities.

‌‌We’ve made Naloxone (Narcan) kits available at 14 UH locations, from inpatient units to EDs, outpatient clinics and pharmacies. This opioid overdose treatment works immediately even for fentanyl, the culprit in more and more opiate deaths. Fentanyl can cause unconsciousness in 90 seconds – well before EMS arrives.

UH retail pharmacies also have these kits on demand, and we will distribute them at health fairs and community events. We’re working on getting them into primary care provider offices and other outpatient locations. This is crucial because more than half the CDC-reported overdose deaths in Ohio had at least one opportunity for intervention.

Another strategy to attack the misuse of opioids is that twice each year, we join forces with Cleveland Clinic for National Prescription Drug Take-Back Day, most recently on Oct. 28.

We know that most people who misuse prescription drugs get them from family and friends, who may have access to pills that were prescribed months or years ago.  The best place to dispose of unused or expired medications is at an official dis‌posal location, and UH and Cleveland Clinic offered 29 of them that day. Free naloxone kits and fentanyl test strips also are provided on each UH Drug Take-Back day.

We address the opioid epidemic in many other ways at UH – for example, through a new and simplified urine testing process for opioids and benzodiazepines forpatients who have been prescribed controlled substances. Testing is important because it increases the likelihood of detecting dangerous opioid and benzodiazepine drug combinations, or drug diversion. A process that used to require four or five separate lab tests now needs just one; as a result, three times as many patients are having the tests done.

At our essence, we are healers – and we treat many patients who have pain for all sorts of reasons, from accidents, injuries and strokes, for example, or from side effects of other treatments, such as those for cancer. In the past, opioids were prescribed for severe pain. They still are in some cases, though usually for a shorter time. But opioids were never a long-term solution, or even all that effective for more than the short term.

So we are always seeking other potent ways to relieve pain.

We are among only two health systems in Ohio to offer a new treatment option for chemotherapy-induced peripheral neuropathy– as well as neuropathy from other causes.

This treatment is known as “scrambler therapy,” and it involves administering electrical stimulation to the patient’s skin via electrodes placed strategically around the site of the chronic pain.  The goal is to replace painful nerve signals with non-painful ones, and “scrambling” how pain is perceived by the brain, whether its source is phantom limb syndrome, sciatica, post-surgical neuropathic pain, peripheral neuropathy or treatment-resistant neuropathic pain.

We also offer many other effective ways to attack pain, especially through the UH Pain Management Institute and UH Connor Whole Health, where clinicians offer many evidence-based interventions to alleviate it. Those can include chiropractic care, integrative/lifestyle medicine, acupuncture, massage therapy, guided meditation and expressive therapy. Often, these interventions are seamlessly integrated into the patient’s care paths at UH.

That is why one of UH Connor Whole Health’s three locations is at the UH Comprehensive Pain Center in Parma. The pain center builds on existing treatments for management of chronic pain, such as injections, spinal cord stimulators and infusion therapy, cryotherapy, the Coflex procedure for spinal stenosis, intracept procedures for chronic lower back bone pain and ketamine infusions.

‌UH also offers a novel Enhanced Recovery After Surgery (ERAS) protocol for patients. It minimizes the use of narcotic pain relievers, gets the patient walking soon after surgery, and shows the patient how to set goals for post-op pain management. These patients have hadshorter hospital stays,fewer post-surgical infections and lower costs. Importantly, ERAS at UH has resulted in a 63 percent reduction in narcotics prescribed at discharge.

‌On another front, we have programs to help those who already are addicted.

One is the THRIVE program in many of our Emergency Departments, which provides support for patients with substance use disorder (SUD) who come to the ED seeking help. If they wish, the patient is immediately connected to a “peer supporter” who helps them get the rehab care needed. These peer supporters have previously struggled with SUD themselves, so they can relate on a personal level to what the patient is experiencing. THRIVE is now also available through telehealth and beyond the ED at UH Cleveland Medical Center as well as at UH Parma and UH St. John medical centers, and it will continue to be expanded.

Another is the Rainbow Interdisciplinary Substance Exposure (RISE) program at the UH Rainbow Babies & Children's Ahuja Center for Women & Children. It provides OB care, addiction care and dual diagnosis care through the RISE Moms clinic, which serves women with substance abuse issues who are considering pregnancy, are pregnant or are within their first-year postpartum. Women are supported through their pregnancy with specialty prenatal and psychiatric care, psychosocial supports through the Rainbow Connects care coordination program and consultations with experts who treat neonatal babies affected by substance exposure.

Some women are in sobriety when they deliver, while others have never been in sobriety. UH strives to connect these patients to the resources they need.

Our efforts against the scourge of opiates and fentanyl are ongoing, as is our vigilance.

‌But let us never forget how important compassion is. No one sets out to become addicted, but it can happen all too easily and unintentionally. And now, more and more street drugs of all kinds are being laced with fentanyl. These stories are devastating, as people can overdose and even die the very first time they unknowingly ingest a substance that might be contaminated with fentanyl, as doses of even just 2 mg - the visual equivalent of 10 to 15 grains of table salt - have been reported to be lethal.

As healers, we must do whatever we can to prevent dependency and save lives, even and especially in the face of overwhelming odds.

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