Opioid overdoses becoming common in GMH E.R.

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Dr. Jeff Hoffmann, along with Robin Esmann, RN, and Joan Parker, RN, BSN, presented information about the nationwide opioid crisis and its local impacts last Tuesday evening. (Press photo by Molly Moser)

By Molly Moser

Dr. Jeff Hoffmann, Robin Esmann, RN and Joan Parker, RN, BSN, presented to a small group at Guttenberg Municipal Hospital on Tuesday, March 27, about the nationwide opioid crisis. Iowa opioid prescription rates are less than many other states, yet are still at 73 painkiller prescriptions per 100 people. 

“When I was trained in the ‘80s, anytime I would use narcotics it was only for short-term, not long-term. Even with cancer, we were really suspicious of opioids,” said Hoffmann. “When new manufacturers came out in the ‘90s to make oxycodone or hydrocodone, they said, ‘Studies show you can give it long term. Patients won’t get addicted, and they’ll never escalate.’ We bought that hook, line and sinker. That’s wrong. It’s not true.” 

Opioids are natural or synthetic chemicals that reduce feelings of pain, such as codeine, vicodin, oxycontin, methadone, diuladid, and others. They can be used for severe short-term and long-term pain, cancer and end-of-life comfort. “As a prescriber I need to weigh the risks and benefits of taking an opioid and consider non-opioid options before prescribing an opioid,” said Hoffmann. 

“I see, very commonly when I’m on call, elderly people that overdose and don’t even know it,” said Hoffmann. “They take opioids with their Xanax or their alcohol or some other type of sedative.” Overdose side effects include pinpoint pupils, weak or droopy muscles, scratching, slurred speech, slowed breathing, loss of consciousness, vomiting, pale face, purple lips or fingernails, and heart arrhythmia that will eventually result in death. 

In 1999, 2.6 million people misused pain relievers. In 2012, 259 million prescriptions were written for opioids. Hoffmann stated that he wrote out eight prescriptions for opioids on the day of the presentation. Many patients have been taking these prescriptions for decades. “I have a lot of patients who are dependent. I’m working through this with each one,” he said. 

Strategies for reducing opioid use include other options for medication, such as Tylenol, NSAIDS like Aleve and Advil, antidepressants and anticonvulsants, which can work well for nerve pain while opioids don’t. Nonmedication treatments like physical therapy, chiropractic care, acupuncture, injection therapies, TENS units and counseling are also being recommended along with alternatives like yoga, meditation, aroma and music therapy.

Opioid abusers can sell their high value prescription drugs on the street for extremely high profits. In 2016, 15,469 people died of heroin overdoses while 42,249 people died of opioid-related presciption drug overdoses – 116 people per day.  The total associated economic cost in 2016 was $1 billion per day; $57 million per hour; $16,000 per second – measured in years of employment and income taxes lost, cost of drugs and cost of treatment. 

Providers are being proactive in addressing opioid abuse. GMH has been participating in a collaborative effort across the state to decrease the amount of opioids prescribed and used or misused by GMH patients. The Opioid Guardianship Quality Improvement Project was led by the Iowa Healthcare Collaborative to ensure patients on opioid medications have treatment plan goals of therapy with care plans for decreasing use. At GMH, doctors, nurses, pharmacists, EMS, and others locally benefitted from resources, peer support, and community outreach provided by the project.

GMH uses a prescription monitoring program, or PMP, which allows providers to access five states’ list of people getting opioid prescriptions before prescribing to a patient. Use of PMPs will become mandatory for opioid prescriptions. Opioid prescriptions at GMH come with pain contracts that require patients to pledge not to ‘doctor hop’ or ‘pharmacy hop,’ submit to urine tests, and lets patients know that a police report will be required for replacement of lost or stolen pills. “I have not yet once seen a police report come in since we’ve put that into the policy, so little pieces are working,” said Joan Parker. 

Pharmacies in Iowa can now dispense naloxone, a nasal opioid reversal agent, without prescription. Area first responders, fire departments and police departments have been trained in the use of naloxone and carry it with them. The Clayton County Sheriff’s Office and Hartig Drug in Guttenberg are anonymous drop-off locations for leftover opioid prescriptions. 

“We know it is an issue and we hear just part of what to do about it – decreasing usage, checking compliance – but the bottom line is state funding for treatment facilities and more open beds for inpatients. There is a critical shortage of that. You need funding to treat the addiction,” said Hoffmann. “The only way that is going to be changed is speaking with congress and politicians to let them know this is a real issue. Treatment is education.” 

Hoffmann, Esmann and Parker will repeat Tuesday night’s presentation in Decorah, Waukon and Cresco in partnership with Northeast Iowa Behavioral Health. To request a presentation for your group or for more information, contact Robin Esmann at 563-252-5531.

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