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Opioid Addiction Doesn’t Discriminate

May 18, 2018

John Vassall, MD
Physician Executive, Quality and Safety
Qualis Health

As a physician, I’ve been following the opioid epidemic for several years. I read a lot about the topic, everything from what’s published in the mainstream news to new studies being released in medical journals. Earlier this year, I began working on an opioid-related project at Qualis Health. The goal of the project is to generate actionable analysis of opioid utilization by Idaho and Washington Medicare beneficiaries. As I got deeper into the work, I realized there’s still so much to uncover as it relates to the opioid crisis. A few things I learned that caught my attention include:

  • According to information from the Centers for Disease Control and Prevention (CDC), deaths from opioid drugs nearly tripled between 1999 and 2014. Yet the amount of opioids prescribed in the United States peaked in 2010 and decreased each year through 2015. While prescriptions may open the door to addiction for some patients, this information suggests illegal opioids, especially street fentanyl, are fueling the rise in mortality.
  • A remarkable 91% of patients who have survived an opioid overdose are still being prescribed opioids one year after an overdose.
  • Opioid use, addiction, side effects and mortality are often associated with young people. In fact, the Medicare population has been hard-hit by opioids. The rate of opioid-related inpatient hospitalizations in the over-65-year-old population more than tripled in Washington State between the years 2005 and 2015. For the 45 states for which reports are available, Washington is second only to Oregon in Medicare beneficiary hospitalizations for opioid complications.

The impact of opioids on elderly patients may have been underestimated, but just as we try to protect our young people, we should engage in efforts to protect our elderly from the problems of opioids.

I believe we need to be more mindful of how we approach the management of pain. Complete elimination of all pain from all patients in all settings is an unrealistic goal, and the relentless pursuit of pain elimination has led to overprescribing and overuse and abuse of opioid drugs.

Rather than attempting to extinguish all pain, we would do better to concentrate on improving function and reducing the source of pain, such as treating inflammation with the appropriate anti-inflammatory medications (opioids do not treat inflammation) and treating strains and repetitive injury syndromes with splints, braces and physical therapy as appropriate.

It’s been revealing to work on this opioid project and begin to uncover previously unrecognized patterns of illness, injury, treatment and complications. As I dive deeper into this information, it’s become clear that we have a lot of opportunity to improve our support of the Medicare population when it comes to the use of opioids.

About the Author

John Vassall is a physician leader with a career spanning more than 30 years. He is an expert in healthcare quality and patient safety whose experience includes nearly a decade as Swedish Health Services’ Chief Medical Officer. Read his full bio.

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