In 2017, the U.S. Department of Health and Human Services declared opioid abuse a national health emergency, following a year when opioid overdoses accounted for 42,000 deaths in the United States. However, despite a comprehensive strategy to combat opioid abuse in the country, dispensing levels remain high in some locations. In 2019, 5% of U.S. counties saw prescription numbers high enough that every person in the county could have their own prescription.
An opioid epidemic driven by a pain epidemic
According to the Centers for Disease Control and Prevention, 50 million adults in the United States live with daily pain. Of those, 19.6 million report experiencing chronic pain that interferes with daily life or work activities. Typical pain management treatment consists of complementary and integrative health, behavioral health approaches, interventional procedures, restorative therapies, and of course, medication.
Meant to treat moderate-to-severe pain following surgeries, injuries, or chronic health conditions such as cancer, opioid treatment was largely indicated for short-term use to alleviate acute pain. However, in the past 15+ years, use of prescription opioids following routine procedures and to treat non-cancer-related pain on a longer-term basis has become increasingly accepted, with medical prescriptions for opioids increasing sharply in the 1990s — a practice that has little evidence to support it and one that increases the risk for overuse, overdose, and addiction. Yet, usage numbers are soaring. With over 150 million opioid prescriptions written for Americans each year, the opioid crisis has become an opioid epidemic.
And, it turns out, with COVID-19, the outcomes are getting even worse.
Opioid use + abuse during COVID-19
Increased pain during the pandemic, whether brought on by postponed and canceled care appointments or even social isolation in chronic pain patients, can lead to increased opioid use. Post-COVID conditions, like “long-haul COVID” can also raise pain levels, leading patients to seek new or expanded pain management. But with the rise in opioid prescription and use comes the risk for opioid abuse.
Recent Mayo Clinic research found that ED visits due to an opioid overdose rose more than 28% in 2020, the first year of the COVID-19 pandemic, as compared to the previous two years. Equally sobering is preliminary CDC data from 2020, which found a greater than 29% increase in opioid overdose deaths as compared to 2019.
In fact, the total number of opioid overdose deaths in 2020 — 93,000 — is the most ever recorded in the United States. Opioid-involved death rates now account for over 70% of drug-related deaths in the country.
The role of health systems in the epidemic
The U.S. Department of Health and Human Services focuses on the five most effective efforts for addressing opioid use disorder:
- Better addiction prevention, treatment, and recovery
- Better data
- Better pain management
- Better targeting of overdose-reversing drugs
- Better research
Similarly, in tackling the opioid emergency, individual health system can focus on efforts like:
- Increasing informed prescribing: Reduce overprescription and unnecessary prescription
- Adapting in an epidemic: Change how pain is treated and managed postoperatively
- Promoting education: Help share proper methods of pill use and disposal
These are critical steps to take, not only to lower opioid-related deaths but to reduce health disparities and encourage health equity.
Health disparities such as widely differing access to care, differential treatment, and reduced health outcomes disproportionately impact communities of color. As the Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One framed it, “This discrepancy in treatment access is important to address at a time when rates of overdoses are increasing for some communities of color.”
Technology to help decrease prescription opioid abuse
While not all opioid abuse comes from prescription pills, prescription opioid abuse presents a massive problem:
- 21-29% of chronic pain patients prescribed opioids misuse them
- 8-12% of people using an opioid for chronic pain develop an opioid use disorder
- 80% of people who use heroin misused prescription opioids first
These stats reveal how critical it is to curb prescription opioid abuse. For example, one study found that, on average, 42-71% of opioid pills prescribed remain unused after surgery, leaving them to be misplaced or abused. Technology like GetWell Loop can help track consumption, pain levels, and medication disposal by peri- and post-operative patients, encouraging responsible use and disposal.
Patients in pain need relief. But without a solid understanding of how much and for how long patients should take opioid medication, we run the risk of overprescribing and subsequent opioid abuse. By tracking and engaging with patients, healthcare technology can help determine the sweet spot, identifying when enough pills have been prescribed without walking the line of overprescription.
The bottom line
The opioid epidemic is an ever-growing problem, and one that has become increasingly urgent during the global pandemic. Technology can play a role in combating it, helping to scale the reach of care teams to track pills and patients alike. This scaled approach can have a ripple effect on health equity and a health system’s ability to reach and treat varied populations.
With opioid-involved deaths at an all-time high, it will take a wide array of governments, hospitals, health systems, and innovators of all types to successfully combat this issue. By working to reduce overprescription, adapt how pain is managed, and promote proper education around the use and disposal of opioids, however, there is hope.
