Overdose is the leading cause of accidental death in the U.S. There has been an all-time high of 81,000 drug-related deaths in 2020.
The drug supply chain
You can divide the supply chain for drug death into two parts: the illegal market and the medicinal market. Illicit fentanyl is dominating the illicit market. It is now coming into our borders. The medical community cannot stop the supply of illicit fentanyl, but they can help with treatment and prevention.
The other end of the spectrum is the medical supply chain for medication overdose mortality, which is under the control of healthcare professionals. In 1999, there was a death rate of 2.0 per 100,000 for unintentional medication overdoses that did not include fentanyl. It reached a peak of 5.7 in 2011. It reached its peak in 2011 at 5.7.
To reduce the death rate from unintentional medication abuse, the medical community must be careful about prescribing. This includes concurrent central nervous system depressants such as opioids, sleep aids, benzodiazepines, and cannabis-related products.
We must coordinate the medication that patients receive from other providers because of the addictive nature of these drugs. It is important to know any other sources where patients might get these neuroactive substances. This includes street purchases, over-the-counter access and taking medications from other people.
The medical community has adopted the CDC Guidelines for Safe Opioid Prescription in Chronic Pain. Some argue that the pendulum may have swung too far in certain places with the denial of opioids.
Innovations in safe prescribing
Safe prescribing is a new approach to managing acute and chronic pain with fewer opioids. Multimodal approaches include
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- psych-behavioral aspects
- Physical modalities
- Procedures
- Alternative medications
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Benzodiazepine stewardship
- A movement is being made towards benzodiazepine management, similar to opioid stewardship. These medications are not the first-line treatment for anxiety and insomnia. Some can be dangerous. Alprazolam (Xanax) is one example. It is responsible for 50% of all benzodiazepine-related deaths. It is the most susceptible to addiction because it has a rapid onset.
Street drugs
- It is common to mix street drugs with illegal fentanyl. Heroin, methamphetamines, cocaine and fake pills of oxycodone, hydrocodone and Xanax are all common drugs involved. Fentanyl can even be found in vaping products. Fentanyl can be found in any drug not purchased from a pharmacy, even if the user does not know it.
- Two ways that the medical community can address this issue proactively are:
- 1. Give naloxone to anyone using illegal drugs (or their loved ones and friends).
- 2. Fentanyl can be included in urine drug screens in hospitals.
- Positive fentanyl tests can alert patients, doctors, and their friends. They also lead to the prescription of naloxone and the disposal of tainted products. Fentanyl testing should always be performed in a hospital setting. You can download a Fentanyl Toolkit to bring fentanyl testing into your hospital.
The Doctors Company closed-claims study
- A strong doctor-patient relationship can facilitate difficult conversations with patients regarding opioids or other CNS depression medications and help reduce the risk of malpractice suits.
- The Doctors Company reviewed 782 cases that were closed between 2015 and 2019 in which patients suffered from medication-related harm. These medications were used in 118 claims (15%). Seventy-four percent of these claims (n=87) were in an outpatient setting.
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- Hospital clinics and physician offices (90%).
- Emergency room (6%).
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- The admitting diagnoses for these outpatient narcotic-related claims were pain, including chronic pain not otherwise specified (NOS) (66%), spine-related pain (7%), joint/extremity-related pain (3%), mental health issues (6%), and drug abuse/dependence (3%).
- Patients made these claims for improper medication management (80%), adverse reactions or unknown allergies (10%) and incorrect dosage (4%)
- These claims were concluded as poisoning by heroin and methadone (53%) and opiates/narcotics nos (20%) and drug dependence (20%), and adverse effects of medication (8%), respectively.
- 48% of all claims involve communication problems contributing to injury. If communication is poor, patients can feel like they aren’t being heard and that the doctor isn’t caring about their concerns or problems.
