Colorado Medical Society

2018 Annual Meeting: Opioid crisis

Thursday, November 01, 2018 12:20 PM

While Colorado’s health care communities have worked closely with public officials and the highly regarded Colorado Consortium for Prescription Drug Abuse Prevention over the course of the last six years to successfully slow the pace of opioid and other substance abuse, there is still a great deal of work that remains.

Giving an update at the 2018 CMS Annual Meeting on the latest in the opioid crisis were Robert Valuck, PhD, RPh, FNAP, director of the Colorado Consortium for Prescription Drug Abuse Prevention, and Jason Hoppe, DO, co-chair of the consortium’s Prescription Drug Monitoring Program Committee and a clinician-researcher, medical toxicologist and associate professor in the Department of Emergency Medicine at the University of Colorado School of Medicine.

Valuck gave attendees a better understanding of the economic consequences of the public health crisis caused by opioid abuse and misuse, and the role of physicians in addressing it.

Physicians are familiar with the sobering statistics: 76,000 people died from drug overdoses in the United States last year and two-thirds of those were related to prescription drugs. In Colorado there were more than 1,000 drug overdose deaths last year, 560 of which were opioid related. “There’s a myth that overdose deaths are mostly caused by illicit drugs but that is incorrect,” Valuck said. “That was a way to reassure ourselves [as prescribers] that our role in this is over and it’s not.”

Drug overdose mortality continues to trend up. Valuck explained that after the first non-medical use of the drug, it takes a person an average of between nine and 13 years to fatally overdose. So for those patients who died from prescription drug overdose in 2017, their first non-medical use likely happened between 2004 and 2007.

“It’s good that prescribing of opioids is going down but it’s going to take a while before we see the decrease in prescribing translate into fewer people becoming tolerant, dependent, addicted, overdosing and dying,” Valuck said. “The numbers will go up before they go down. We project that 150,000 people in the United States will die from prescription drug overdose before the numbers turn downward. We’ll see it in about eight to nine years. We have to do things urgently to keep people alive.”

In terms of the economic impact, for every one overdose death – and there were 560 in Colorado last year – there are 10 treatment admissions for abuse, 32 emergency department visits, 130 people who meet diagnostic criteria for substance use disorder, and 825 people who admit to non-medical use of an opioid in the past year. The estimate from the Centers for Disease Control and Prevention using 2013 data is that this costs the economy $80 billion per year in medical costs alone. The president’s council of economic advisors estimated the cost to the economy as $504 billion per year using 2016 data and accounting for lost productivity, taxes, criminal justice and the value of a statistical life. Altarum, an independent think tank, estimates that over the past 15 years the epidemic has cost society in the United States $1 trillion and that over the next four years it will cost society an additional $500 billion in its impact.

“It’s a huge problem no matter how you slice it,” Valuck said. “It’s a tremendous cost.”

Hoppe spoke about improving prescribing decisions and the treatment of conditions with alternatives to or with fewer opioids. “I don’t like the term ‘alternatives,’” Hoppe said. “I think opioids should be the alternative and we should consider everything else first. We had been taught that opioids have as high of efficacy and safety as other drugs and that is not correct information.”

The medical community, he said, must share responsibility for the crisis. We will have an active role in the solution but we need direction in how to improve our practices to balance safety while maintaining quality care and cost control. “We owe it to our patients and the community. The public believes that this is up to medicine to fix.”

Hoppe said the way to change physician behavior is through education and feedback, correcting perceptions and clarifying standard of care, and making it easier to access services and treatment options.