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A Guide to Help Physicians Identify Opioid Misuse in the Midwest

A Guide to Help Physicians Identify Opioid Misuse in the Midwest

From July 2016 to September 2017, the Centers for Disease Control (CDC) reported that the Midwest region of the United States experienced a 70% increase in opioid overdoses. Wisconsin, Michigan, and Ohio are 3 regions hit hardest by the opioid epidemic. The statistics are staggering in comparison to the national average.In February 2018, the National Institute on Drug Abuse (NIDA) reported that 15 people per every 100,000 died from an opioid overdose in Wisconsin, Michigan and Ohio, 13% higher than the national average. Individually, all 3 states are far above the national average, with Ohio ranking in the top 5 for number of opioid overdose deaths.There were 72,000 overdose deaths in the United States in 2017, of which nearly 48,000 were attributed to opioid overdoses.  This is due to a significant spike in the usage of synthetic opioids - such as the illicitly manufactured fentanyl (IMF).  The CDC cites the constant change in the IMF market, and that fentanyl can be found in combination with heroin, counterfeit pills, and cocaine.

Opioid Epidemic Update

The 2018 Health Trends: Drug Misuse in America report evaluated 3.9 million patient drug tests. The study discovered that more than half of patients misuse their medications.The study defined misusage as an inconsistent result: additional non-prescribed drugs were detected, at least 1 prescribed drug is not detected, but 1 nonprescribed or illicit drug is present, or none of the prescribed drugs are found.The medical profession is keenly aware of the opioid epidemic that has gripped the United States, with the number of prescriptions dispensed falling 10.2% in 2017 from 2016. In 2017, the rate of prescription misuse declined among patients receiving care from a clinician or pain specialist. However, the rate of misuse among patients is still problematic.Federal and state government officials have taken note, passing regulatory and legislative restrictions across the United States. The state of Ohio released an Action Plan to Address Opioid Abuse in May 2017. In December 2018, Michigan’s Department of Licensing and Regulatory Affairs released new rules for Substance Use Disorder facilities to improve patient care and reduce regulatory burdens on licenses.Reducing the impact of the opioid epidemic requires expertise and time from everyone, especially medical practitioners. As the decision makers on how to best treat patients, knowing the signs of possible substance abuse is the first step.

Recognizing Opioid Misuse In Patients

Screening patients for possible opioid misuse depends on the circumstances. Opioid abuse may first be noticed by a loved one who notifies a doctor of their concerns, while other patients may be red-flagged by a doctor or pharmacist because of their insistence on continuing their prescription.It’s not always easy to determine. However, here are a few ways for medical professionals to screen for opioid misuse.

Use Prescription Drug Monitoring Programs

While each state varies in how they make the system accessible and the ease of use, the results have shown several positive outcomes, including changes in prescribing patterns, decreased use of multiple providers by patients, and a decrease in substance abuse.In April 2017, Michigan updated their program to Michigan Automated Prescription System (MAPS). Wisconsin offers the Wisconsin Enhanced Prescription Drug Monitoring Program, and Ohio established their Ohio Automated Rx Reporting System (OARRS) which updates every 24 hours.

Consult the DSM-5

The American Psychiatric Association outlines an 11-point checklist for diagnosing a substance abuse disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (or DSM-5). According to the DSM-5, patients must have experienced 2 of the 11 symptoms within the past year.
  • Taking a substance in larger or longer amounts than intended
  • Unsuccessful attempts to curb usage
  • Excessive amounts of time spent obtaining, using or recovering from a substance
  • Cravings or strong urges to use the substance
  • Repeated failures at home, work or school
  • Continued opiate usage despite social or interpersonal problems
  • Withdrawal from normal activities socially and professionally
  • Reckless behavior
  • The need for additional substance to achieve intoxication
  • Continued usage despite physical or psychological problems
  • Obvious withdrawal symptoms

Managing Chronic Pain

In 2014, Stefani A. Hudson, MD, and Leslie A. Wimsatt, PhD wrote How to Monitor Opioid Use for Your Patients With Chronic Pain for the American Association of Family Physicians (AAFP). It provides a protocol for practitioners to follow.They acknowledge physicians’ reluctance to prescribe opioids for pain management due to the risk of misuse and addiction. They recommended “establishing policy and procedures would minimize differences between individual providers' approaches to chronic pain management and the associated confusion that we feared made it easier for misuse and abuse to fly under the radar.”The detailed multi-step process evaluates any patient considered a candidate for chronic opioid therapy. In it, the patient is given information, a prescription, and is required to sign a controlled substance agreement. Patients must also take a urine drug test.  While it is recommended that physician consult with their state’s prescription drug monitoring program, the results of the urine test help determine the best courses of action for treating a patient.

Drug Screen Tools

Beyond the recommendations listed on AAFP’s website, physicians have other tools to identify patients who may be at risk for drug dependency. Screening tools are available to help examine a patient’s family and personal history when it comes to alcohol, illegal and prescription drug usage and what it may mean in the future. Here are a few examples:Opioid Risk Tool (ORT) - This brief, self-reporting screen is used with adult patients in primary care settings to assess risk for opioid abuse in patients with prescriptions for pain management.Screener and Opioid Assessment with Pain - Revised (SOAPPⓇ - R) - Intended for patient’s being considered for pain management prescriptions, this self-reported screen dives deep into a patient’s risk for possible opioid dependency.

Early Detection

The earlier misuse of opioids can be detected, the better. Prolonged usage can cause irreversible chemical and structural changes to the brain. That’s why doctors play such a critical role - they’re often one of the first to know.One of the quickest ways to determine whether a patient is misusing opioids is to send them for testing. Seventy percent of medical decisions are made from test results. For more information, contact the nation’s leading medical test provider.