Opioid Addiction Crisis

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Opinion: Spurred By Crisis, Long-Awaited Fix To Mass. Opioid Database

With the state's opiate epidemic in full swing, some fixes for long-standing problems are finally happening, writes Dr. David Scales. (Toby Talbot/AP)

With the state’s opiate epidemic in full swing, some fixes for long-standing problems are finally happening, writes Dr. David Scales. (Toby Talbot/AP)

Update: According to the Committee of Interns and Residents, which advocated for resident access to the database, the state has now fixed this gap and residents can be entered into the system at the hospitals where they work. 

By Dr. David Scales

State officials are promising that by this March, they will fix a long-standing problem: Currently, doctors in training — more than 5,000 of us statewide — have no direct access to the database that lets us check a patient’s opioid history.

Sometimes, it seems, it takes a crisis to push for change. With the opiate epidemic in full swing, some fixes for long-standing problems that make no sense are finally happening. If only we could fix more of the ridiculous aspects of our health care system — some elements of our electronic medical records come quickly to mind — without waiting for a crisis.

The database is a major piece of the state’s effort to stem the overdose epidemic. Checking its critical data on patients’ past prescriptions can mean the difference between prescribing a much-needed pain medication or wrongly prescribing what turns out to be an overdose.

I first learned that residents had no access to the database when I started my own residency in 2013. At my first outpatient appointment, I saw a homeless man on such high doses of morphine and Dilaudid, an opioid pain drug, that I was surprised he was alive. Doses that high would cause most people to overdose.

His legs were swollen to the size of tree trunks, with skin a texture not too far from bark. But he was on opiates for pain control after a recent hernia repair that was complicated by an infection. During his recovery at a rehabilitation facility, a physician had thoughtlessly escalated his medication regimen. Now he was about to be back on the street, and had no one to prescribe his pain medications. When opioids are abruptly stopped, withdrawal can include intense symptoms from abdominal pain and vomiting to skin-crawling and muscle aches.

Yet only one physician in our clinic had access to the online prescription drug database and it took days to get the printout she kindly provided. Fortunately, we could wait, because the man was still hospitalized, but even as a new resident, I could see that this gap in the system simply made no sense. Multiply my experience by the 5,500 resident physicians in Massachusetts and you see the scope of the problem: One out of every seven doctors in the state is excluded from this key database.

Jennifer Lipman is a third-year podiatry resident colleague at Cambridge Health Alliance, and her story is even more absurd. For one patient, Jennifer called seven pharmacies, spending close to an hour listening to hold muzak while pharmacists searched their databases for prescriptions of controlled substances.

The online prescription monitoring program was developed in the first place to avoid situations exactly like Jennifer’s. It provides faster, easier access to information on prescriptions from hospitals and pharmacies across the state, to indicate whether a patient has been visiting multiple health care providers to gather prescriptions for controlled substances.

But Jennifer couldn’t access the database directly because of technical problems that impede access for individual residents. Currently, log-in privileges are tied to official registration numbers for physicians. Residents have a number linked to their residency program rather than an individual one like fully licensed doctors.

Many residents in Jennifer’s shoes would have given up. But through sheer persistence, she found out her patient had been prescribed a lot of Vicodin: 270 tablets in the past 30 days from various sources. That was a helpful red flag. It would have been more helpful if it had taken her two minutes instead of an hour.

Access to the database may seem like a small thing, but it has big implications. Continue reading

Mass. Medical Society Calls For Changes To Key Provisions In Baker’s Opioid Bill

The head of the Massachusetts Medical Society (MMS) is calling for lawmakers to change two key provisions in a bill that Gov. Charlie Baker says is needed to fight the state’s growing opioid addiction epidemic.

The Joint Committee on Mental Health and Substance Abuse held a hearing on the legislation Monday, during which MMS President Dr. Dennis Dimitri urged changes to two controversial proposals: limiting first-time opioid prescriptions to a three-day supply, and letting hospitals hold addiction patients against their will for up to three days while trying to place them in treatment.

Testifying before the committee, Baker defended the proposals, saying they are necessary to stem the problem.

“For some patients in the throes of this addiction, the choices may be between a jail cell, a coffin or treatment through this proposed process,” Baker said. “I choose the latter over the other two.”

According to a press release, MMS President Dimitri testified that the involuntary commitment proposal “cannot work without access to treatment resources and post-hospitalization care.”

Dimitri also said that involuntary commitment “could further exacerbate” the problem of emergency department overcrowding “without actually benefiting patients.”

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Who Is Overdosing In Boston And When

A call goes out to 911. Sirens scream through the streets.

Boston EMS responded to 135,040 calls last year. More than 2,000 of them (2,038 to be exact) were patients with narcotic related illness (NRI), based on the observations of an EMT.

The vast majority involved heroin. Pleas for help with an overdose were a small segment of EMS calls. But the upward trend is “just striking,” said Boston EMS Superintendent in Chief Brendan Kearney.

(Click to enlarge)

(Click to enlarge)

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Massachusetts Doctor On The Power And Limitations Of Narcan

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

A common treatment for anyone who overdoses is the drug naloxone, also known as Narcan.

Naloxone is touted as an invaluable tool in the battle against heroin and other opiate overdoses because it can temporarily reverse the effects and restore breathing. But some doctors warn that naloxone is not a cure-all and has some limitations.

Dr. Ed Boyer, chief of the Division of Medical Toxicology at UMass Memorial Medical Center in Worcester, joined Morning Edition to explain. Continue reading

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It’s Not Just Heroin: Drug Cocktails Are Fueling The Overdose Crisis

Anthony, seen here in Chelsea, says he has overdosed 12 times. His really intense highs were produced by heroin, sometimes with an alcohol chaser, and pills. (Martha Bebinger/WBUR)

Anthony, seen here in Chelsea, says he has overdosed 12 times. (Martha Bebinger/WBUR)

A bald man in gray sweats bounds into the brick plaza next to City Hall.

“Hey,” someone calls out, “where you been?”

“At the hospital,” the man named Anthony says. “I OD’d.”

A half dozen people watching shake their heads. It’s a bad week in Chelsea, they say, with three overdose deaths.

“They’re dropping like flies,” says Theresa, a woman who manages a rooming house and does not want to share her last name.

Anthony, whose last name we’ve also agreed not to use, says he overdosed the night before on a particularly strong bag of heroin, laced with fentanyl, the dealer said, or something like it.

“[The dealer] told me how strong it was,” Anthony says, “but everyone says that to sell their dope.”

Fentanyl, an opiate that is many times more powerful than heroin, was present in about 37 percent of overdose deaths from January through June of last year, based on 502 cases analyzed by the Office of the Chief Medical Examiner in Massachusetts. Continue reading

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Fentanyl-Related Deaths Up Sharply In Mass.

The number of fentanyl-related overdose deaths is up sharply in Massachusetts.

State police, which conducts toxicology tests for the state medical examiner, say that fentanyl was present in 336 people who died of overdoses in a 12-month period that ended on Oct. 6.

That’s up more than 50 percent from the previous 12-month period.

Fentanyl is a synthetic opioid that is much more potent than morphine and is often mixed with another substance such as heroin.

A report last month from the Centers for Disease Control and Prevention found Massachusetts had the second-highest number of fentanyl confiscations in 2014, with 630 seizures by U.S. law enforcement.

Massachusetts Attorney General Maura Healey has proposed a bill that would make trafficking in fentanyl a crime.

State officials have said there were more than 1,200 overdose-related deaths in Massachusetts last year.

Related:

Baker Announces Campaign To Remove Stigma Of Addiction

A screenshot from a new statewide media campaign, created by the state, about addiction (YouTube)

A screenshot from a new statewide media campaign, created by the state, about addiction (YouTube)

In June, Gov. Charlie Baker announced an opioid addiction awareness campaign aimed at parents. On Wednesday, he launched another statewide media campaign; this second one — #StateWithoutStigMA — seeks to end the stigma around drug addiction.

The new campaign, according to a release from the governor’s office, is “designed to impact the negative stereotype of drug misuse, asserting that addiction is not a choice, it’s an illness.” Continue reading

Boston Nonprofit Plans To Open A Room For Supervised Heroin Highs

Dr. Jessie Gaeta, chief medical officer of the Boston Health Care for the Homeless Program, stands in a conference room, which the organization hopes will soon serve as a place where heroin users could ride out a high under medical supervision. (Jesse Costa/WBUR)

Dr. Jessie Gaeta, chief medical officer of the Boston Health Care for the Homeless Program, stands in a conference room, which the organization hopes will soon serve as a place where heroin users could ride out a high under medical supervision. (Jesse Costa/WBUR)

A room with a nurse, some soft chairs and basic life-saving equipment. Together, this is the latest tool a group of local doctors and nurses plans to create to fight the state’s opiate epidemic.

Though it doesn’t have all the funding yet, Boston Health Care for the Homeless Program  (BHCHP) plans to open the so-called “safe space,” where heroin users could ride out a high under medical supervision, at the beginning of next year at the corner of Mass. Ave and Albany Street.

“It really is the epicenter of opiate overdose in Boston,” Dr. Jessie Gaeta, the BHCHP chief medical officer, says of the area where, if all goes according to plan, the space will open.

Gaeta says she and her colleagues are desperate to offer an option for the people they see overdose every day, whom they must sometimes step over to get into the program’s clinic.

“The epidemic feels like it’s been crescendoing on this block,” Gaeta says of the stretch of Mass. Ave known as the “Methadone Mile.” “We’ve got to try new things.”

There have for months been hushed conversations among opiate addiction providers about creating a Supervised Injection Facility (SIF) in Boston. Nine countries around the world have such facilities — where men and women inject heroin or ingest other illegal drugs, under the guidance of a nurse or other medical professional. The only one in North America is in Vancouver.

There does not appear to be much political support for creating an SIF in Boston. The room at Boston Health Care for the Homeless would just be a supervised space where men and women in the throes of a high would be monitored, and then urged to try treatment.

“It’s not a place where people would be injecting,” Gaeta says. “[It would be] a place where people would come if they’re high and they need a safe place to be that’s not a street corner or not a bathroom by themselves, where they’re at high risk of dying if they do overdose.”

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