Doctors detail scope of opioid epidemic
Why are the richest and freest people in the world killing themselves at shocking rates via opioids?
That was one of the questions posed by Graham Hetrick, Dauphin County's coroner, to a panel of medical experts at the 2018 Health Care Symposium hosted by the Central Penn Business Journal on Tuesday morning.
All sang a common tune: The cause is multi-layered. But so is the fight against it.
Doctors at the symposium mentioned alternative pain management treatments. Insurance companies, such as Highmark Inc., are carrying out steps to limit the number of opioid prescriptions being written. Gov. Tom Wolf declared a state of emergency for the opioid crisis and recently extended it.
Employers can join the battle by offering employee assistance programs to their employees and their families.
Employee assistance programs are often a gateway to treatment, said Dr. Caesar DeLeo, the senior medical director at Highmark Blue Shield and a panelist at the symposium
But before the opioid epidemic gets any better, it’s going to get worse, DeLeo said. "Opioid addiction, I dare say, is the polio of our time."
Another panelist, Dr. Sarah Kawasaki, likened the opioid epidemic to the HIV/AIDS crisis, pointing out that the number of opioid-related deaths has exceeded the number of deaths caused by the HIV crisis at its peak.
"If we were talking about an infectious disease crisis today, the deaths are so astonishingly high that most of us would probably be afraid to come to this room because we would be worried that we would all catch it," said Kawasaki, an internist and addiction medicine specialist at Penn State Health Milton S. Hershey Medical Center in Derry Township and Pennsylvania Psychiatric Institute in Harrisburg.
The epidemic was caused by a combination of factors, but over-prescription of opioids is a prominent one, panelists said.
Dr. Jennifer Chambers recalled that when she received medical training it was routine for doctors to treat pain by ordering IV morphine every two hours as needed in addition to ordering Tylenol.
"The intensity of this pain medication related to the intensity of the pain was not really being assessed," said Chambers, senior vice president and chief medical officer at Capital Blue Cross.
According to her research, one in five Blue Cross members received an opioid prescription in 2015.
"Imagine. One in five people, in a one-year time frame, of all the members of the Blue Cross system, had received an opioid prescription," she said.
Many ended up addicted. Between 2010 and 2016, the number of people diagnosed with opioid use disorder rose 500 percent, according to Chambers.
Today, more than 250,000 Blue Cross members have been diagnosed with opioid-use disorder, Chambers said.
That’s why opioid-use disorder, she said, should not be stigmatized, but rather recognized for the medical condition that it is, one that crosses all lines in society.
"There is no financial, socio-economic or cultural barrier related to this crisis. It’s an equal opportunity crisis," Chambers said.
Opioid prescriptions for adults should not exceed five days, while a prescription for a child should not exceed three, she noted.
Nonetheless opioids are not an appropriate way to treat pain as the first or even third line of treatment, Chambers said.
Deep massage therapy, acupuncture therapy and even yoga have proven to be effective ways to manage pain, Chambers said.
Often, opioid prescriptions may open the window to other types of opiates such as fentanyl, which can be more deadly.
"That gives you an idea of why the mortality rate, the age of the deaths is coming down. Because people can just experiment and die very quickly because of the advent of fentanyl," Hetrick said.
In Dauphin County, DeLeo said there are two types of fentanyl. One is 1,000 times stronger than heroin. The other is 7,000 times stronger.
"We are in the middle of a public health crisis, but by coming together we can beat this epidemic," DeLeo said.
Highmark, Capital Blue Cross and Penn State Health were sponsors of the symposium.