Issue link: http://viewer.e-digitaledition.com/i/643923
DE ATH DUE TO opioid overdose is at epidemic proportions in Ohio, and many physicians are on the front lines trying to safely treat patients in pain without contributing to the epidemic. Consider the facts. Ohio's death rate due to unintentional dr ug poisonings increa sed, bet ween 2000 a nd 2012, by 336 percent — mostly due to prescription drug overdoses. In 2007, unintentional drug poisoning became the leading cause of injury death in Ohio, surpassing motor vehicle crashes for the first time. In 2014, six to seven Ohioans died each day from a drug overdose. In light of this, the Governor's Cabinet Opiate Action Team (GCOAT), in collaboration with Ohio clinicians' associations, medical licensing boards, and healthcare providers, issued three opioid prescribing guidelines in the last four years: The first, in 2012, for emergency departments and acute care facilities; the second, in 2013, for treatment of chronic pain lasting longer than 12 weeks; and the third, in January of this year, for the treatment of patients with short-term acute (less than 12 weeks) pain. These guidelines are intended to help healthcare providers review and assess their approach in the prescribing of opioids. They are not intended to take the place of clinician judgment, which should always be utilized to provide the most appropriate care to meet the unique needs of each patient. Despite the collaborative eŸorts of legislators, physicians and pharmacists across the state, drug overdose deaths in Ohio continue to increase — from 2,110 in 2013 to 2,482 in 2014. In September 2015, the Ohio Department of Hea lth released this statement, "At the same time we are experiencing positive progress in our fight against drug addiction, such as fewer opiates being dispensed and a decrease in high-doses of opiates, we are also seeing some individuals begin to use more dangerous drugs to achieve more intense eŸects." Heroin is one of those drugs. More easily accessible and less costly than prescription drugs, heroin accounted for almost 50 percent of drug related deaths in Ohio in 2014. Fentanyl is another dangerous drug. In 2013, 84 deaths were attributed to Fentanyl overdose. In 2014, there were 502 — an increase of almost 600 percent. Why? There are two possible explanations. First, when Fentanyl patches became available in a generic formulation, they were designated by many medical insurance companies as a first-tier long-acting opioid. This automatically led to an increase in Fentanyl prescriptions. Second, there is a misconception among clinicians that shifting from oral opioids to subcutaneous opioids, like Fentanyl patches, will decrease the risk of opioid overdose and death. The fact is that Fentanyl is 30–50 times more lethal than heroin. In an eŸort to save lives, the Ohio Department of Health and GCOAT have been expanding the availability and distribution of naloxone (Narcan), which can reverse the eŸects of an opioid overdose. Pharmacists are now empowered to provide education and dispense naloxone overdose kits without a prescription from a physician. Currently, Western Reserve Hospital's pharmacy, New Choice, is one of four pharmacies in northeast Ohio doing this. Hopefully, more will follow suit and make this life-saving medication available to a broader audience In addition, I recommend that education programs for the general public, as well as health care providers, be continued. Also, physicians should consider co-prescribing naloxone when prescribing opioids in high risk populations, such as elderly patients, obese patients, patients with sleep apnea, patients on high dose opioids and/or on combined therapy with benzodiazepines/hypnotics. For more information about opioid prescribing guidelines and resources for prescribers, visit opioidprescribing.ohio.gov. Dr. Samer Narouze is the Chair of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio. He is also Clinical Professor of Neurological Surgery at Ohio State University, Clinical Professor of Anesthesiology and Pain Management at Ohio University College of Medicine, Associate Professor of Surgery at Northeast Ohio Medical University, and President of the American Interventional Headache Society. ■ 1 2❱❱❱❱❱ S P E C I A L C L I N I C A L S E C T I O N in Ohio The OPIOID OVERDOSE EPIDEMIC BY SAMER NAROUZE, MD, PHD 1 2