By DENNIS GRUBAUGH
Opioids are threatening the lives and livelihoods of the local workforce like never before, and leaders agree they must work together to address the crisis.
That was the message of a recent presentation at OSF Saint Anthony’s Health Center, where more than 50 health care, law enforcement, civic and business professionals and employers gathered to talk over solutions.
The statistics are frightening:
- Since 1999, the amount of opioids prescribed for pain and sold in the U.S. has quadrupled.
- In 2013, providers wrote close to a quarter-billion prescriptions for opioids — enough for every adult in the U.S. to have his or her own bottle of pills.
- 64,070 died of drug overdoses in 2016, more than any year on record. Approximately, three-fourths of all these drug overdose deaths are now caused by opioids like heroin and fentanyl.
- The use of pain killers in Madison County in 2015 was 126 pills per man, woman and child.
Ajay Pathak, president and CEO of OSF Saint Anthony’s puts the issue in context.
“It’s probably the most significant public health and public safety challenge that we’re fighting in Illinois today. I read somewhere that by 2020, the majority of deaths of people under 50 in our state will be related to the opioid epidemic. That is really staggering.”
The hospital is holding a series of luncheons targeting health-care issues, and this one stirred the interest of attendees, several of whom commented that they would like to be more involved.
“We hope this is the starting point to foster more discussion,” Pathak said. “Ultimately the crisis that we find ourselves in today was not created by one or two situations. It’s a multitude of factors that have come together to create this crisis and epidemic.”
OSF HealthCare, the parent organization of Saint Anthony’s, has incorporated the opioid issue as a key part of its long-range plan, he said, targeting prevention, treatment, education, and working with the community more closely on current and untapped resources.
The hospital is partnering with Alton Memorial Hospital on a HOPE Task Force — for Hospital Opioid Engagement. Officials have been meeting on a quarterly basis to discuss their procedures.
OSF recently rolled out a drug-takeback program, adding a lockbox at the hospital, Pathak said.
Addressing a variety of topics were three authorities from OSF Saint Anthony’s — Dr. Dennis Sands, chief medical officer; Suzanne Ringhausen, manager of Psychological Services and Employee Assistance; and Matthew Cary, lead nurse practitioner in the Emergency Department.
Opioids include painkillers such as morphine, methadone, Buprenorphine, hydrocodone, and oxycodone. Heroin is also an opioid and it is illegal. Opioid drugs sold under brand names include: OxyContin, Percocet, Vicodin, Percodan and Demerol among others.
Sands said the pace of prescription rates parallels the increase in addiction. The amount of pain really hasn’t changed, so prescribing more narcotics is not the answer, he said.
Pharmaceutical companies have overproduced the pills and were not forthcoming about their addictive nature, he said.
The U.S., which makes up 5 percent of the world’s population, represents more than 80 percent of opioid consumption on the planet, he said.
Most of the overdoses are from of opioids like heroin and fentanyl, he said.
Often, illegal opioids are laced with other drugs — and the user is unaware. Heroin, for instance, is often laced with fentanyl, which is 100 times more potent than morphine. Most resultant deaths are accidental, Sands said.
The number of fatalities in Madison County has stayed steadily high, he said. Last year, there were 85 such deaths. So far this year, at his last check with the coroner, there were already 16, Sands said.
The dangers of heroin use, of course, have been widely reported. There is the potential for immediate addiction. Brain receptors are changed upon the first use of the drug, Sands said, making recovery so much more difficult.
Sands thinks a community effort is needed because the epidemic touches everyone. Crime rates go up, prices of goods increase to cover losses due to theft and the overall cost of health care rises.
He outlined a series of things to combat the problem, from supporting legislation for insurance companies to cover treatment cost; to quicker access to treatment; to expanded use of the drug Suboxone and Narcan, which respectively are used to treat addition and overdoses.
Law enforcement must investigate overdoses as homicides and identify the person who supplied the drug and prosecute them, Sands said.
In December, Gov. Bruce Rauner signed SB 772, requiring prescribers to register with the Illinois Prescription Monitoring Program, a database recording patient prescription history. However, only a few providers are actively using the database, he said. Providers need education and guidelines, he said.
Meanwhile, there is meaningful work going on by groups like Partnership for Drug-Free Communities, Chestnut Health Systems and others. And, Walgreens and CVS are now stocking Narcan nasal spray. Distribution and training includes police, previous addicts, family members and care providers.
Ringhausen addressed the effects on employers. Absenteeism, medical costs and productivity are among concerns.
Some 70 percent of the estimated 14.8 million Americans who use illegal drugs are employed, she said.
Congress enacted the Drug Free Workplace Act in 1988, mandating that employers have policies dealing with substance abuse.
In 1991, the U.S. Department of Transportation was the first to mandate drug screening.
Quest Diagnostics, a leading provider of diagnostics information, has said that over the last two decades, employment positivity rates for drug screens have been mostly going down.
However, during the last three to five years, there has been an uptick, specifically in marijuana, methamphetamine and, since 2011, heroin, which is up 140 percent, Ringhausen said.
The trends are making worker recruitment and retention increasingly difficult, with no end in sight.
Drug screening policies can be very complex, she said, but they are a necessity in light of one of the most important concerns of employers, which is safety of the workers, coworkers and the public. Work injuries and worker’s compensation are a ramification.
Health insurance, too, is a worry, and costs have been on the rise, but there has been research that when individuals enter treatment successfully, their health insurance costs — and their family’s — can go significantly down.
Regarding opioid prescriptions, the National Safety Council surveyed employers last year and found only 19 percent of human resources personnel were confident that they were prepared to handle the crisis at the worksite. However, the vast majority wanted to hear more about options other than painkillers for pain management. And, 70 percent want to help employees return to work following treatment.
Years ago, health officials looked at drug use differently, quantifying drinking and all illegal drugs as a general danger. Opioids, which are not always illegal, are another story.
“We do know opioids are different and much more serious. The brain is truly hijacked,” Ringhausen said.
To protect the workforce, the stigma of drug use must be decreased, workplace drug policies re-evaluated, employees educated, and supervisors trained, Ringhausen said. Insurance policies must be checked for coverage. Workers must feel they have an avenue for treatment.
“Sometimes it’s our best employees who may fall suspect to this,” she said. “They’ve got chronic pain, they don’t want to call off. They tough it out and just double dose on their pain meds. And down the road we go.”
Speaking from his perspective in emergency medical treatment, Matthew Cary said pain management is difficult because it’s so subjective — it’s what the patient says it is. You can’t rely on a 1 to 10 scale because one person’s 10 might be another person’s 5. The time and type of conversation the provider has with the patient is significant.
“Given that patient satisfaction is provided at least in part through pain management, providers must at least be sensitive to whether they are meeting the expectations related to the subject,” Cary said.
Among considerations in judging whether opioids should be administered are allergies to other medicines, and prescribing practices of physicians who work from the same office and share patient loads
A big question, he said, is responsibility for prescriptions.
“Who’s responsibility in management of pain? Is it primary care? Is it pain management (specialists)? Is it the emergency department? What if the patient is in acute pain? Is the patient himself responsible for his pain?”
CEO Pathak said hospital officials have tempered their initial approach in talking about pain.
“I will tell you frankly and honestly, we’ve changed our approach on that discussion and dialogue,” Pathak said. “We’re not necessarily of the mindset that zero pain in every patient is the ultimate outcome. We really have to understand it on a case-by-case basis.”
Police Chief Jason Simmons, who was in attendance, said he thinks it might be worthy to have an awareness campaign that educates people on what some drugs actually look like.
“I would guess, as I look around this room, that many of the people here don’t actually know what a button of heroin even looks like. I think the first thing, as community stakeholders, is we need to organize a drug awareness seminar for nurses, teachers and other people.”
The Drug Free Alton Coalition, represented by Greg Gelzinnis at the luncheon, meets the third Thursday of every month at noon at Castelli’s Restaurant at 255. It has been hosting meetings on drug awareness for almost 12 years. However, last year its federal grant money ran out and the organization needs assistance in continuing to spread its message, he said.
“We’d love very much to talk to organizations and potential funders. Education and prevention is huge. We’re learning every day of new twists,” he said.
More information on OSF’s programs are available through its Behavioral Health Navigation Link, (309) 308-8150 and at osfhealthcare.org.