Health care leaders must drive solutions for the opioid crisis
September 12, 2018
THREE RIVERS, MI – The Center for Disease Control (CDC) recently released its annual report on drug overdose deaths in America and its bad news for Michigan. According to the report, the Great Lakes State experienced an 8 percent rise in overdose-related deaths last year. Overdoses in the state claim more than seven lives a day, far outpacing the number of suicides, traffic fatalities or gun deaths over the same interval.
As Michigan and other states are in the midst of a national discussion about the opioid epidemic, the conversation often focuses on users of prescription opioids who become addicted. But what many people don’t know is the impact the crisis has on our healthcare workers and our environment. The epidemic isn’t limited to patients — easy access to controlled substances can lead to addiction among healthcare employees, and discarded medications wreak havoc on the environment.
Healthcare workers have easier access to opioids than anyone else. Pharmacists, nurses and technicians can easily grab a pill bottle, syringe or patch out of a stockroom or trash can. Last year the Department of Veterans Affairs reported nearly 2,500 yearly drug thefts throughout the VA hospital system alone — and that’s only the ones they caught.
These thefts aren’t always a bottle or two. Hospital drug diversion is a problem on a massive scale — in 2013, two Georgia pharmacists were convicted of stealing more than a million pills over five years. When workers take medication, they’re hurting their hospitals, their patients and themselves. It is imperative to protect both health workers and patients by limiting easy access to potentially addictive medications.
Opioids aren’t only dangerous to hospital workers. The impact on the environment is rising as well. Most patients and health workers casually dispose of medicine in sinks or toilets, ignoring the effects of these highly toxic materials. The FDA even encourages flushing opioids down the toilet, directing the waste straight into our waterways.
According to a study in Integrative Medicine, 80 percent of American waterways are contaminated with pharmaceutical waste, much of it due to billions of pills discarded every year. As a consequence, humans and animals are ingesting small but increasing levels of opioids in our drinking water — leading to effects like mussels that test positive for oxycodone. By recklessly dealing with leftover and excess pain medication, our health systems endanger the lives they work to protect.
These two problems — hospital drug diversion and environmental impact from improper disposal — are the hidden side of the opioid crisis. While the public is finally realizing the problem of addiction and the government is cracking down on abuse, these problems continue under the radar.
But the factors that have made physicians longstanding, albeit unwilling, accomplices in this part of the opioid epidemic are the same ones that can position them as uniquely able to drive its resolution.
First, health leaders can adopt new technologies that provide a fresh opportunity to stymie drug diversion. At Three Rivers Health, for instance, we’ve implemented a system called Cactus Smart Sink. It’s a box where doctors, nurses or patients can drop leftover pills, rendering them environmentally harmless and non-retrievable by those who struggle with opioid dependency. Waste management technologies like the Smart Sink help us keep all discarded medications under lock and key, instead of letting them feed the public health crisis we ought to be fixing.
Second, we can improve internal hospital rules. One major contributor to hospital diversion is lax internal rules and oversight, which can be addressed by fixing hospital procedures. The Mayo Clinic is a picture of success in this area, successfully empowering all employees to combat abuse and diversion in their facilities. By making oversight a priority, hospitals and pharmacies can prevent theft, addiction and harm for both workers and patients.
Finally — and most importantly —as an industry, we must prescribe fewer opioids altogether. Aside from a handful of chronic pain disorders like fibromyalgia, pain is more often a symptom to be investigated than a disease to be treated. Though many patients need their medication, rates and quantities of these prescriptions should be conservative and limited. Cutting back on excess prescriptions is an across-the-board solution, mitigating diversion, abuse, and environmental effects all at once.
Treating addiction isn’t enough. We as healthcare leaders need to lead the effort to address the unrecognized problems of hospital drug diversion and environmental contamination. With new technology and procedures that confront these problems, we can first arrest and then reverse this epidemic. Healthcare leaders can’t fix the opioid crisis alone — but we’re in the best position to start.
Dave Shannon is the Interim CEO of Three Rivers Health in Three Rivers, MI