Opiate and misuse: The toll on society and solutions moving forward

Opiate and misuse: The toll on society and solutions moving forward
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It never leaves them alone.

He sold his parents’ television, even after they changed the house locks as counseling instructed. They were waiting for a place for outpatient treatment, but he reused before they could get him there. Now they are waiting for the call, not that he’s in jail, but…

This isn’t everyone’s story, but many of us know this story exactly. Too often family members, schools, coaches, businesses and communities ponder about the life lost and “What could have been?” The numbers are staggering.

According to the Center for Disease Control and Prevention, March 2018, the rates of ER admissions for overdoses rose by 30 percent nationwide, over 70 percent in the Midwest, with the highest rate of increase in Wisconsin by 109 percent.

Opiates are very important for the urgent relief of pain — the pain of cancer, the pain of breaking several bones at once. Often their need is questionable for other kinds of pain, e.g., ankle sprain, wisdom tooth extraction.

Doctors were told through the 1990s that they were shamefully undertreating pain, and this may have been true for a small and important part of the time. Doctors were told, and allowed themselves to believe, that opiates were virtually safe.

The National Institute of Drug Abuse reported in February 2018 that Wisconsin has an overdose rate 14 percent higher than the national average. Overdose is only one important impact, but so also is the drastic disruption to family and work.

What can be done?

While we need to treat pain, we urgently need to not use opiates for less severe pain when alternatives, including nonmedication alternatives, are available. We know that 80 percent of people who move to heroin started with prescription drugs.

After reviewing the March 2017 CDC guideline for opiate drug use, WEA Trust instituted an “opiate rule” for patients who had not had opiates before, we would allow a one-week prescription and a refill if necessary, but the member had to call if they needed more pills to reassess the diagnosis.

Along with other efforts in the environment, this program has decreased pills per person by 26.6 percent. This statistic is not only alarming, it highlights the ease with which these potent medications are readily available.This simple but aggressive approach is making a difference. In the first six months of 2018 after implementing this procedure, 106,457 fewer doses were sent out into Wisconsin homes and communities, reducing the chance of someone becoming a chronic user or falling into abuse of these powerful and addictive drugs.

This epidemic must be fought on many fronts. Health experts, medical professionals, law enforcement and others are looking into solutions to address this national crisis. We will continue to work on the effects of addiction, but just as important on the prevention of addiction. We urge all Wisconsin and regional insurers to implement short prescription fills for opiate naive insured persons.

This column was written to help further the discussion of how to address the growing opiate crisis. By each of us sharing our programs and findings, perhaps we can avoid the tragedy of addiction for many and save lives. The opiate epidemic has no single silver-bullet solution to address all the nuances of this horrific addiction, but if we can reduce the opportunity for someone becoming a chronic user and the likelihood of future abuse, perhaps we may not have to ask, “What could have been?”

Dr. Tim Bartholow, Vice President & Chief Medical Officer, WEA Insurance Corporation

As Chief Medical Officer, Dr. Tim Bartholow is tasked with leading all clinical functions to achieve safer more affordable care, focusing on proper access, appropriateness, harm avoidance, and engaging members to action. He encourages community health with board service to Wisconsin Literacy, United Way of Dane County, and the Wisconsin Collaborative for Health Care Quality. He advises Venture Investors, KIIO, the University of Wisconsin Master of Public Health Program, Wisconsin Community Health Fund, and the University of Wisconsin Population Health Institute (publishes County Health Rankings).