He got the call nearly 12 hours after his daughter failed to show for work. One pill too many, the coroner said. And now this once-vibrant millennial is an opioid epidemic statistic.
Each day, at least 116 people in the United States die from an opioid overdose. And who are these overdose victims? Teens. Women. Senior citizens. People with chronic pain. The highly addictive nature of opioids drives many to self-medicate with street opiates when their pain isn’t adequately managed. It’s a crisis that health and wellness professionals across the globe are struggling with. Here are four ways population health managers can play their part in fighting the epidemic.
1. Use technology to identify addiction risk factors.
The Centers for Medicare and Medicaid (CMS) encourages healthcare entities to incorporate their Opioid Risk Tool into electronic health records (EHRs) to better monitor use, identify risk, and achieve better pain management practices in patients with chronic pain. They’ve set limits for opioid prescriptions and have called on health payers to establish drug management programs for potential at-risk Part D beneficiaries effective January 1, 2019.
That’s a good start. Two in five people who are prescribed long-term opioids for chronic pain will misuse them, and as many as 15 percent will become addicted. Opioid misuse and overdose death is highest among working age adults (25 to 64), men, and populations with low socioeconomic status.
The U.S. National Pain Strategy for Population Research recommends evaluating pain using the Pain, Enjoyment, General activity (PEG) scale and including that data in EHRs as well. Practitioners can evaluate this information in conjunction with other risk factors – such as self-reported opioid misuse, either by taking more than prescribed or borrowing medication from others – to identify opioid addiction risk.
2. Ask the right questions.
The U.S. government has declared the opioid crisis a public health epidemic and allocated billions of dollars to fight it. HHS Secretary Thomas Price, M.D., identified five strategies to combat addiction during the 2017 National Rx Drug Abuse and Heroin Summit:
Studies point to genetics and environmental factors such as loneliness, transitions such as a divorce or job loss, and community attitudes as risk factors for opioid abuse. A good health risk assessment (HRA) gathers information on a person’s current health and lifestyle that may be linked to addiction, such as:
- Is the individual anxious or stressed?
- Do they have positive social support?
- Do they have a history of alcohol abuse or a smoking habit?
- Are they sleeping well?
- Have they had a recent traumatic event?
- Are they physically active?
- Do they live in a rural area?
- What is their income?
- Are they depressed?
- What is their level of pain?
Looking at physical, social, and environmental cofounders such as these can help identify addiction risk, so add the data to your EHR so it is easily accessible by other health and wellness practitioners. Predictive data like this can help healthcare professionals intervene upstream of addiction with non-addictive approaches to pain management.
3. Design wellness programs that promote non-opiate pain management.
Some pain, such as back pain, can be prevented with fitness and proper ergonomics. Educate your population on proper posture, lifting techniques, and other ergonomic principles. Encourage regular physical activity and good nutrition that promotes spine health, including vitamin D supplementation.
You may want to offer strength, balance, and stretching classes for your population. A recent meta-analysis reports that low-impact exercises that focus on strength and balance/coordination are more effective for treating non-specific low back pain than exercises focused on cardiovascular fitness. Low-impact exercise is a recommended first-line treatment for both prevention and management of osteoarthritis, low back pain, and fibromyalgia. But people in pain often avoid movement that hurts. If HRA data shows that an individual has chronic pain, take a look at their physical activity minutes. Present the benefits of exercise interventions to reduce pain. Physical activity that contributes to a healthy weight and waist size is especially beneficial because it lowers inflammation and improves pain outcomes.
It can be hard for people to stick with an exercise routine. Change readiness data can help you identify individuals prepared to take action.
4. Population health managers ensure health benefits cover alternative therapies.
Physical therapy and exercise therapy are highly effective pain management techniques and are generally covered by insurance plans. Other effective modalities include complementary health approaches such as yoga, acupuncture, spinal manipulation, and therapeutic massage, and cognitive behavior therapy (CBT). Mental health embedded into a multidisciplinary pain treatment approach can improve chronic pain, function, mood, and sleep according to a recent study. Does your health benefit plan cover these treatment modalities?
It takes all of us – health payers, health and wellness professionals, patients, and government and community agencies – working together to combat the opioid epidemic. No one should hear from the coroner that their loved one took one pill too many.
Emotional agility can help your population handle stressful situations, reducing the risk of opioid abuse.