Faces of Geneia: Meet Kevin Jacoby
At any one time, Kevin and his department works with more than one thousand patients.
September 07, 2017
Heather Lavoie, Chief Strategy Officer
Earlier this summer, U.S. News and World Report published a story with the headline, “New Hampshire: Ground Zero for Opioids.” Not long ago, New Hampshire was known to outsiders as the home of the First in the Nation Presidential Primary and the Old Man of the Mountain. Not anymore.
Sadly, New Hampshire is now infamous for its number two ranking in opioid-related deaths and increasingly for its distinction as the state with the most per capita deaths related to fentanyl, an opioid that’s 50 to 100 times stronger than heroin.
As a life-long resident raising my kids in the Granite State, I find the statistics sobering. Even more so is how close to home the issue of opioids has come to me and virtually everyone I know. A few weeks ago, I joined the board and staff of the Granite United Way at a meeting with the former police commissioner of New Hampshire’s largest city, Manchester, and current state drug czar, David Mara. He opened the meeting by asking, “Please raise your hand if you or your family has not been touched by the opioid crisis.” Not a single hand went up. And he went on further to make the point, that heroin and fentanyl addiction never starts with a needle, rather, it begins with a pill.
New Hampshire’s Opioid Epidemic Has Impacted All Granite Staters
Given the statistics I found in my research, I suppose I shouldn’t be surprised at the extent to which New Hampshire’s opioid epidemic has impacted all of us Granite Staters.
Here is a snapshot of what I learned about the opioid crisis in the United States and my home state of NH:
At the risk of repeating myself, let me reiterate and emphasize the significant spike in opioid prescriptions.
In just six years, the amount of opioids prescribed per person jumped three times and “was enough for every American to be medicated around the clock for three weeks.”
The drivers of the opioid epidemic are many, but certainly the troubling escalation in opioid prescriptions is a primary cause.
In defense of prescribers, the opioid crisis, in many ways, has exploded overnight. A quick glance at the table below of NH’s overdose deaths involving opioids shows a big spike between 2013 and 2014.
Yet, the crisis has garnered the attention of key policymakers like the CDC, which first issued prescribing guidelines in March 2016. In July 2016, 45 of 50 governors at a meeting of the National Governors Association endorsed a compact aimed at tightening prescribing rules. In August 2016, then U.S. Surgeon General Vivek Murthy sent a letter to every physician in the country, asking for help with the opioid epidemic. He noted that few American public health problems have cost more lives. Opioids even emerged as an issue in the 2016 Presidential campaign.
Given the scale of the epidemic and widespread attention to the issue of opioid over-prescribing, I am perplexed that the behavior of prescribers does not seem to have changed much, if at all. Dentists in my area continue to routinely prescribe opioids for simple teeth extractions, and patients whose wisdom teeth are removed often receive multiple prescriptions. As do knee replacement patients.
A few weeks ago, a friend recounted her husband’s pre-surgical experience with an orthopedic surgeon, one that I fear is still far too common. In advance of knee replacement surgery, the physician prescribed opioid painkillers. Telling the physician he wanted to avoid exposure to opioids, her husband asked for alternatives. The surgeon was surprised, even a bit resistant. My friend and I too were surprised. We wrongly assumed the preponderance of evidence about the opioid epidemic had altered default prescribing patterns.
Clearly, we need to do more. Although it has rankled physicians, I am encouraged by moves like pharmacy benefit manager Express Scripts’ intention to limit the number and strength of opioid drugs to first-time patients.
I am also quite enthusiastic about the advent of analytics models to predict opioid addiction. If physicians and dentists knew in advance which of their surgical patients were predisposed to opioid abuse, they could counsel high-risk patients about the risks and prescribe alternatives.
That’s why companies like Geneia are prioritizing the creation of a predictive analytics model for opioids. I wish it were a simple and lightning-quick process. It’s not.
The process starts with descriptive statistics. We’re mining our data to determine the demographics of the opioid-dependent such as:
We have developed a robust research environment for our data scientists to apply their skills against exactly these types of real-world problems. Stay tuned. We’ll be writing more about our opioid analytics model in the coming months.
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Fred Rahmanian is the technological visionary for Geneia's products.