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:
- In 2015, there were more than 33,000 fatal opioid overdoses nationally
- On average, 91 people die each day in the U.S.
- For every fatal overdose, there are approximately 30 nonfatal ones
- In New Hampshire, fatal overdoses jumped 148 percent from 2010 to 2015 when the number reached 439
- During the month of July 2016, New Hampshire experienced 666 opioid-related emergency department visits. At 279, people aged 20-29 were the most frequent ED users followed closely by those aged 30-39 at 226. The thirty-somethings experienced a 46 percent increase from June 2016.
- The amount of opioids prescribed per person was three times higher in 2015 than 1999. “In 2015, the amount of opioids prescribed was enough for every American to be medicated around the clock for three weeks.”
- According to the Centers for Disease Control and Prevention (CDC) Vital Signs report released in July 2017, the national average in 2015 for opioid prescriptions was 640 morphine milligram equivalents (MME) per person, up from 180 MME in 2010.
- In 2015, all but two of New Hampshire’s 10 counties in NH exceeded the national average of 640 MME. Two counties, Coos and Carroll, topped 1,110. Carroll County had the largest increase, climbing from 902.7 MME per person in 2010 to 1128.5 in 2015.
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.
Prescribing Patterns Perplex Me
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.
Developing Analytic Models to Predict Opioid Addiction
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:
- Gender demographics
- Age distribution
- Top five prescribing physician specialties
- Number of different physicians prescribing an opioid prescription in a calendar year
- Number of emergency department visits as compared to non-addicted population
- Number of opioid claims per 100 people for addicted and non-addicted population
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.