I recently attended a local Charleston (S.C.) Medical Society meeting, the theme of which was the opioid crisis. Although at the time I did not see a perfect relevance of this crisis to hospital medicine, I attended anyway, hoping to gain some pearls of wisdom regarding what my role in this epidemic could be.
I was already certainly aware of the extent of the opioid epidemic, including some startling statistics. For example, the burden of the crisis totaled $95 billion in the United States in 2016 from lost productivity and health care and criminal justice system expenses.1 But I was still not certain what my specific role could be in doing something about it.
The main speaker at the meeting was Nanci Steadman Shipman, the mother of a 19-year-old college student who had accidentally overdosed on heroin the year prior. She told the story of his upbringing, which was in an upper-middle-class suburban neighborhood, full of family, friends, and loving support. When her son was 15 years old, he suffered a leg injury during his lacrosse season, which led to a hospital stay, a surgery, and a prolonged recovery. It was during this period of time that, unbeknownst to his family, he became addicted to opioids.
Over the years, Nanci’s son found ever more creative mechanisms to procure various opioids, eventually resorting to heroin, which was remarkably cheap and easy to find. All the while in high school, he maintained good grades, remained active in sports, and had a normal social circle of friends. It was not until his first year of college that his mother started to worry that something might be wrong. In less than a year, her son quit sports, and his grades spiraled. Despite ongoing family support and extensive rehab, he suffered more than one setback and accidentally overdosed.
After her son’s death, Nanci started a nonprofit organization, Wake Up Carolina.2 Its mission is to fight drug abuse among adolescents and young adults. They use a combination of education, awareness, prevention, and recovery tactics to achieve their task. In the meantime, they try to diminish the shame and secrecy among families suffering from opioid addiction. During Nanci’s presentation at the medical society meeting, the message she conveyed to us – an audience full of physicians – was simple: We can either be part of the problem or part of the solution; we all have a duty to help and a role to play in this crisis. Whether a patient is exposed first inside the hospital or outside of it, for a short period of time or for a long one, every opioid exposure comes with a risk. Nanci’s story was incredibly affecting and made me rethink my personal role in this epidemic; how might I have contributed to this, and what could I do differently?
Shortly after her son died, her younger son suffered a femur fracture during a football game. You can imagine the horror her family felt knowing that he would need some pain medication for his acute injury. Nanci and her family were able to work with the medical and surgical teams, and through multimodal pain regimens, her son received little to no opioids during the hospital stay and was able to recover from the fracture with reasonable pain levels. She expressed gratitude that the hospital teams were willing to listen to her and her family’s concerns and offer both pharmacological and nonpharmacological therapies for her son’s recovery, which allayed their fears about opioids.
From this incredibly powerful and moving story of one family’s experience, I was able to gather some very meaningful, evidence-based, and tangible practices that I could implement in my own organization. These might even help other hospitalists take an active role in stemming this sadly growing epidemic.
As hospitalists, we should work on the following:
- Improve our personal knowledge of and skills in utilizing multimodal pain therapies regardless of the etiology of the pain. These should include both pharmacologic and nonpharmacologic interventions.
- Use consultants to assist us with difficult cases. Depending on our practice setting, we should utilize consultants who can give us good advice on nonopioid pain management regimens, such as palliative care.
- Try to influence the practice of surgeons and other specialties that consult us, to help shape prescribing patterns that include nonopioid medical regimens, and to get doctors used to entertaining nonpharmacologic pain-reducing interventions.
- Limit the volume of prescription opioids written to our patients at the time of hospital discharge. There is mounting literature that suggests leftover prescriptions can be the start of an opioid addiction for a family member.
- Educate ourselves and our patients about any local “take back” programs that allow for safe, secure, and anonymous drops of prescription medications. This may reduce opioids getting into the hands of someone who might later become addicted.
- Find out whether our hospitals or health systems have a pain or opioid oversight group or team, and if not, see whether there is interest in starting one.
- Look into local community activist programs to partner with for education, awareness, prevention, or treatment options (such as Wake Up Carolina).
- Work with local resources (for example, case management, social workers, psychiatrists) to learn about and utilize local options for rehabilitation. We should actively and openly discuss these options with any patients known or suspected to be addicted.
- Make a valiant attempt to remove any unconscious bias against people who have become addicted to opioids. Continuing the social stigma of addiction only spurs the shame and secrecy.
