Scientific approach to opioid crisis saves lives
FAbbie Roth
rom mid-2016 to mid-2017, more than 5,200 opioid overdose deaths were recorded in Ohio, making it the third-deadliest state for overdoses, according to the Centers for Disease Control and Prevention. The opioid epidemic — declared to be a national public health emergency in October 2017 — claimed more U.S. lives in 2016 than were lost in the Vietnam War.
And yet, those statistics don’t come close to tallying the loss experienced by children. Their parents are dying. They live in unstable environments. They are born addicted and spend their first weeks in withdrawal. They are becoming addicted as teens, repeating the pattern.
Addiction and the opioid crisis affect every demographic — every age, gender, ethnicity and pay grade. The problem is complex, and so are the solutions. One sector or institution can’t solve it all, but how can pediatric health care help?
Quality improvement, or QI, is one way. It’s a systematic framework used to improve how care is delivered to patients. It’s not officially a research study, but it uses scientific methods and principles of measurement, analysis and control with a specific aim. When targeted at problems resulting from addiction or, better yet, preventing addiction, the impact of QI can be profound.
For example, babies with neonatal abstinence syndrome (NAS) experience withdrawal because they were born to mothers who were using opioids, sometimes illicitly, sometimes appropriately under doctors’ orders. The Ohio Perinatal Quality Collaborative developed an extensive QI program, including weaning protocols to systematically reduce the amount of medication needed to manage the infants’ withdrawal symptoms, greater investment in supportive care such as breastfeeding and cuddling, and expanded staff and parent education. As a result, babies with NAS in Ohio are spending less time in the neonatal ICU and experiencing better outcomes.
Sometimes, children require medication to manage pain because of an illness or injury. Because of QI initiatives at Nationwide Children’s Hospital, physicians are writing fewer prescriptions for opioids and fewer pills per prescription, after discovering that most patients did not use all the pills ordered. Additionally, QI initiatives have improved education for families about safe usage, storage and disposal of medications.
People with behavioralhealth concerns are at a higher risk for addiction. In many cases, substance abuse begins as an attempt to selfmedicate against depression, anxiety or other behavioralhealth problems. Screening for behavioral-health concerns in primary-care visits and when prescribing medication in the case of an illness or injury can help identify those at risk for addiction. Many practices are using QI to increase the rates and effectiveness of their screening for behavioral-health concerns.
Adolescents and young adults with addiction need comprehensive treatment. Medication-assisted treatment combined with therapy from a professional trained in addiction and dual diagnosis can help them maintain sobriety. However, retention in a substance-abuse program is a major challenge. From 2009 to 2012 at Nationwide Children’s, only 9 percent of patients stayed in the program for 12 months. Through a QI project, retention increased to 40 percent at 12 months and 60 percent at six months.
These are just a few examples of how QI can help children and families affected by the opioid crisis. Furthermore, research can help us answer additional questions about addiction, recovery and prevention. That’s another topic for another column.