Doctor says key to eliminating opioid overdoses is education

SEATTLE — Numbers from the Centers for Disease Control released earlier this month show it was another record year for overdose deaths in the U.S.

"Preliminary data shows that for 2017, we had roughly 72,000 Americans die from a drug overdose and at least 50,000 of those were related to narcotics, including prescription narcotics heroin and fentanyl."

Dr. Keith Brown is Chief Medical Officer for Community Health Plan of Washington – the only not-for-profit Apple Health — or Medicaid — plan in Washington state.

He says the CDC numbers show about a 7-percent increase in opioid-related deaths, nationally, for 2017 compared to 2016, about the same increase in deadly opioid overdoses we saw in Washington state, according to Brown.

However, if you add deadly overdoses linked to meth, he says the overall increase is closer to 10 percent with Washington state seeing seeing larger increases in deaths linked to meth than many other states.

Brown says the key to getting the opioid overdoses down is education on all sides.

How to fight opioid overdoses
One interesting method, comes from a recently published University of Southern California study where prescribing doctors received letters from the LA County Medical Examiner.

"Send a letter to a primary care physician letting them know that one of his or her patients died of an overdose — that does influence the behavior of that prescriber."

Specifically, Brown says, that study found doctors were more cautious after learning patients died and they wrote fewer opioid prescriptions. The ones they did write were for smaller quantities.

Locally, Brown says the state Health Care Authority and Community Health Plan are using a different letter writing campaign to discourage doctor shopping.

Doctor shopping
"We basically identify people who are visiting multiple prescribers and are at high risk for abusing opioid pain medication, and who have multiple visits to the emergency room," Brown said. "We send them a letter, and the evidence is that just getting a letter appears to have a very positive effect on reducing the abuse of narcotics in those individuals."

"It's a warning letter. It's a very friendly letter, which basically kind of says we've noticed that you are visiting multiple prescribers or have had multiple prescriptions or multiple emergency room visits, and we've noticed this and we want to help steer or direct you toward more appropriate services with one provider and maybe one pharmacy," Brown said. "Now, underneath that certainly is a message that is, in effect,  we're watching you."

He says that seems to do the trick because those doctor shoppers often end up following the recommendations in the letter, and seek out more appropriate health care.

"More appropriate health care would be having one primary care doctor who is able to screen for mental health and substance use conditions and then either treat in the office or refer people to a sub-specialty provider for substance use, if necessary, and then one prescriber, rather than multiple prescribers."

Shifting to street drugs
In both the local and the USC letter campaigns, the overall goal is to reduce the number of prescription opioids out there that can potentially be abused.

But Brown says just cutting down on the number of prescription opioids in circulation is not good enough.

"If you just limit the prescription drugs and do nothing else, there is the danger of helping to shift people to the more dangerous street drugs," Brown said. "So you have to combine the limitation of prescription drugs with treatment for heroin and fentanyl and you have to have both remedies in place, like medication assisted treatment, sober living facilities, drug rehabilitation programs. You have to have all components in place. If you just limit the prescription pills alone, you're probably not going to address the whole problem."

Brown says that includes having mental health treatment available with an estimated 45 percent of all those addicted to drugs also suffering from an underlying mental health issue.

Another intervention Brown believes is key to successfully dealing with the opioid epidemic is harm reduction, including syringe exchanges and safe injection sites.

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