Opioid Epidemic in New York

Opioid Epidemic in New York

Opioid-related deaths are a significant health problem in the United States. In 2017, overdose deaths involving opioids were 47,600, with 17,029 deaths from commonly prescribed opioids and 15,482 heroin deaths. The deaths prompted the Department of Health and Human Services (HHS) to declare the opioid crisis a public health emergency (NYSDOH, 2019). Combating the epidemic requires collaboration among health professionals, government, policymakers, and other interested parties in implementing effective strategies, which include prevention, access to treatment for opioid addiction, and overdose reversal drugs. Senator Pete Harckham, the Chair of the Senate Committee on Alcoholism and Substances Abuse, needs to gather support for bills presented by Senators Anna Kaplan, Brian Benjamin, and Toby Stavisky, requiring the expansion of the prescriber education in tackling the opioid crisis in New York State.

Opioid Epidemic in New York

In 2017, overdose deaths in New York involving opioids were 3,224, a rate of 16.1 deaths per 100,000 persons. The rate was higher than the national average of 14.6 deaths per 100,000 persons (NYSDOH, 2019) despite low prescription rates. The opioid prescription rate among New York health providers was 37.8 for every 100 persons, which was one of the lowest in the country and below the national average of 58.7 prescriptions per 100 persons. Between 2010 and 2017 in New York State, the age-adjusted rate of deaths involving all opioids increases threefold from 5.4 to 16.1 deaths per 100,000 population. What is most concerning is the exponential increase in synthetic opioid-involved deaths (mainly fentanyl) from 210 in 2013 to 2,238 in 2017; 1,194% increase. Also, in the same four year period, heroin-involved deaths increased from 666 deaths to 1,356 deaths. Although there was an increase in prescription opioids deaths in the same period from 859 to 1,044, the rate of increase was slower compare to synthetic opioid- and heroin-involved deaths.

The rapid rise in the number of deaths as a result of the opioid crisis shows that it is an unprecedented crisis. Furthermore, the epidemic had adversely affected the lives of those with opioid use disorders (OUD) as well as their families and friends. Also, there is an increase in the number of infants requiring specialized care following a diagnosis of neonatal abstinence syndrome. Individuals with opioid use disorders are more vulnerable to human immunodeficiency virus (HIV), hepatitis C, and chronic diseases (National Institute on Drug Abuse, 2019). The economy also suffers due to the opioid crisis as individuals with opioid use disorders are not in a position to maintain employment, cater to their healthcare costs, costs for emergency medical responses and law enforcement efforts, and cost for county coroners and medical examiners in the case of death.

History of Opioid Use

The use of opium in the U. S. dates back to 1775. In the 1860s, opioids were used to treat soldiers during the civil war, but many of them became addicted. In the late 1800s, there was a sharp rise in opioid addiction as the over-the-counter availability of opioids increased. Heroin pills were available for pain relief ad coughs. In the early 1900s, morphine use for pain management was common (Jones et al., 2018). By 1910, Americans were crushing opioid pills and inhaling them for pleasure. The Harrison Narcotics Act of 1914 regulated opioid limiting their recreational use. Between 1920 and 1950, opioid prescriptions were limited to the redying for acute pain rather than for chronic pain to avoid addiction. In the 1970s, doctors avoided prescribing opioids due to the stigma of addiction and instead opted for surgical operations to block nerves from receiving pain signals. However, in the 1980s, opioid prescriptions resumed. In the 1990s, the use of opioids to manage chronic pain skyrocketed following a report from the pharmaceutical companies that reassured the medical community that opioid pain relievers were not addictive. The increase in prescriptions resulted in a corresponding rise in the misuse of both prescription and non-prescription opioids. By 2017, the opioid overdose death rate had risen to 142 per day.

Prevention Strategies

Prevention efforts are in three levels: primary, secondary, and tertiary. Primary prevention aims to stop overdoses and substance use disorders before they occur. The New York State Department of Health (NYSDOH) launched a program to educate healthcare providers on the appropriate prescribing of opioids (NYSDOH, 2019). Other efforts included educating New Yorkers to raise their awareness that opioids can be dangerous and addictive and increasing the number of people not using opioids nonmedically through evidence-driven prescription opioid overdose prevention ad campaign. The Prescription Monitoring Program (PMP) also helps in reducing the number of opioid prescriptions given by providers. The program collects and analyzes data on dispensed controlled substances from dispensing practitioners and pharmacies. The design of the PMP allows access through a smartphone or tablet. Currently, NYSDOH is taking the necessary steps to integrate the NYS PMP within a healthcare provider’s electronic health record (EHR) (NYSDOH, 2019). Between 2017 and 2018, there was a 10% reduction in the number of opioid analgesic prescriptions and a 15% reduction in the number of “doctor shoppers,” individuals who receive opioid prescriptions from at least five prescribers and dispensed from art least five pharmacies within six months.

Secondary prevention aims at reducing the impact of opioid use disorders that have already occurred. NYSDOH efforts include increasing access to three types of Medicated Assisted Treatment (MAT) for opioid use disorders: buprenorphine, methadone, and long-acting naltrexone (NYSDOH, 2019). Tertiary prevention aims at minimizing the impact of opioid use disorders that has lasting effects. It involves helping people in managing long-term, usually complex problems to prevent life-threatening adverse outcomes. NYS leads in implementing public health programs targeted at preventing death from opioid overdoses through an approach that focuses on expanding overdose response capacity within communities across the State. Educating community members on how to administer naloxone (an opioid antagonist) in the event of suspected opioid overdose is the fundamental of the health program.

Prescribers Education

The NYS Medicaid Prescriber Education Program (MPEP) is a comprehensive education and outreach program for prescribers. MPEP was established to meet the requirement by NYS legislation for the NYSDOH to develop a prescriber education program in collaboration with an academic institution. The goal of NYS MPEP is to promote better health outcomes by offering practitioners with information unbiased, evidence-based pharmacotherapy (NYSDOH, 2019). The NYS partners with the State University of New York (SUNY) in implementing MPEP. The program has two main modules: an academic educator outreach program and a web-based program. Accreditation Council accredits each module for Continuing Medical Education, and upon completion, prescribers are awarded 0.5 CME credits. In 2014, an academic module on Chronic Non-Cancer Pain (CNCP) was added as the demand for opioid prescriptions increased. Practitioners with a large volume of Medicaid members receive priority in the educational sessions focusing on CNCP.

In 2017, NYSDOH collaborated with SUNY Buffalo to develop a web-based opioid prescribing training program that met legislated education requirements (NYSDOH, 2019). The program was in response to legislative changes in Public Health Law that require medical residents prescribing under a facility U.S. Drug Enforcement Administration (DEA) and prescribers with a DEA number to complete a minimum of 3 hours of education every three years in 8 particular topics that include pain management, addiction, and palliative care. Over 43,000 prescribers have completed the education program since its inception. Participants must achieve over 70% score on the post-test to receive CME credits. Results from the program show a 10% and 20% increase in Part I and Part II scores between pre- and post-testing, respectively.

Bills Supporting Prescriber Education

On February 04, 2020, the Senate advanced bills to fight substance misuse and protect New York communities from the adverse effects of opioid addiction. Senate passed legislation that considers the complexity of the opioid epidemic, provides support to individuals fighting addiction and healthcare providers and expands government services. Three of the bills support medical education for prescribers: S.2507, S.7102-A, and S.7132. S.2507 promotes the expansion of the screening, brief intervention, and referral to treatment (SBIRT) program beyond hospital emergency rooms by requiring the development of new training materials for use by qualified health professionals (New York State Senate, 2020). S.7102-A requires the DOH to update the mandatory 3-hour training for prescribers on controlled substances to include the most up-to-date guidance and evidence-based practices. S.7132 requires medical and mental health providers to receive training in pain management and substance use disorders.

The opioid epidemic is a significant health problem in the United States. An exponential increase in the number of deaths involving opioids in recent years calls for intensified efforts in prevention strategies. Primary intervention strategies aiming to avoid opioid addiction before it occurs should be at the frontline. One such approach is educating prescriber education on controlled substances and substance use disorders. Therefore, Senator Pete Harckham needs to gather support for bills presented by Senators Anna Kaplan, Brian Benjamin, and Toby Stavisky, requiring the expansion of prescriber education in tackling the opioid crisis in New York State.