Opioid use and addiction has claimed thousands of lives and resulted in a doubling of the number of people who reported heroin addiction in a single decade, from 2003 to 2013. The costs are staggering, with an estimated $20 billion spent annually on emergency room visits and hospital care. The epidemic has reverberated through the criminal justice system and into the streets, as people dealing with substance use disorder struggle to find a way out.
The problem is especially pronounced in Oregon, where a recent national report revealed Oregon had one of the highest cumulative increase of opioid-related hospitalizations of any state between 2009 and 2014.
As the state’s only public academic health center, OHSU is on the forefront of efforts to address this epidemic in Oregon and throughout the country.
The hospital can be a critical stop for many people who suffer from opioid misuse or addiction, often arriving with medical conditions such as endocarditis or severe joint or spinal infections. Physicians and nurses understandably treat the acute symptoms of overdose or infection, but haven’t typically addressed the underlying cause. This results in people cycling endlessly through the system, driving up costs and failing to help people end their addictions.
Honora Englander, M.D., an associate professor of medicine in the division of hospital medicine in the OHSU School of Medicine, recognized a glaring need.
“There was an enormous gap in substance use care,” Englander said. “In the hospital setting we had no ability to assess, let alone address, people’s addiction needs.”
Researchers at OHSU began to systematically assess the experience of people who arrived in the hospital with conditions related to their opioid use. A study published Dec. 13 in the Journal for General Internal Medicine laid the groundwork for a unique model to help people overcome their addiction and reduce the burden on the health care system.
“Our study shows that hospitalization is a reachable moment for initiating and coordinating addiction care,” Englander and colleagues concluded.
Known as Project IMPACT, or the Improving Addiction Care Team, the study resulted in an initiative that brings together physicians, social workers, peer-recovery mentors and community addiction providers to tackle the root causes of addiction when patients are admitted to the hospital. The initiative began in 2015, and is already beginning to see results.
OHSU also is focused on reducing the number of people who become addicted to opioids in the first place.
The epidemic spiraled out of control beginning in the 1990s, with an increased focus on helping patients to manage chronic pain. Pharmaceutical companies began marketing opioids to treat chronic pain beyond its previously established use in cancer treatment, palliative care and end-of-life care.
Now, physicians are beginning to reconsider patients’ dependence on opioids to manage pain.
Roger Chou, M.D., director of the Pacific Northwest Evidence-based Practice Center at OHSU, co-authored a set of opioid-prescribing guidelines issued by the U.S. Center for Disease Control and Prevention in 2016. The guidelines provide a set of clinical practice recommendations to help primary care physicians ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse or overdose from these drugs. Further, Chou along with other OHSU experts contributed to guidelines issued in February 2017 by the American College of Physicians recommending physicians use non-drug therapies to treat low back pain.
In addition, OHSU is among a group of medical schools across the country that have pledged to implement meaningful training in the safe prescription of opioids. Todd Korthuis, M.D., and Melissa Weimer, D.O., have been active in working with primary care providers throughout Oregon to improve treatment of addiction through professional training and a new Addiction Medicine Fellowship program. Korthuis and Weimer recently received grant funding from the U.S. Substance Abuse and Mental Health Services Administration to provide Project ECHO – telehealth-based training – for providers throughout Oregon to improve access to addiction medications and treatments.
Scientists at OHSU are continually exploring new avenues to manage pain through alternatives to opioids as well as advancements in basic science.
Two recent examples include a new study by Susan Ingram, Ph.D., exploring the possibility of harnessing the medicinal properties of cannabis while minimizing the risk of addiction. Richard Deyo, M.D., recently co-authored a new study examining the link between initial opioid prescribing and long-term risk of addiction.