Tech vs. the Opioid Crisis
How Connecting Systems Can Help
May 14, 2018

More than 3,000 Americans die every month from an opioid overdose. This urgent epidemic impacts not only public health across the nation, but social and economic welfare as well. The Centers for Disease Control and Prevention (CDC) estimates that prescription drug misuse costs the United States over $78 billion per year for treatment, law enforcement and lost productivity. Those that may have someone close to them struggling with opioid addiction, look into drug test kits as well as looking for a rehab facility, if the person in question is willing to attend.

In addition to policy, technology can play a major role in the country’s response to the crisis. Here, Director of Healthcare Strategy Bryan Young discusses how connecting systems together can help doctors make better decisions, and reduce the amount of opioids in circulation.

(Doctor) Shop till you Drop

Starting in the late 1990s, healthcare providers began prescribing opioid pain relievers in greater numbers. This was in part because pharmaceutical companies mistakenly assured doctors that the drugs were non-habit forming. However, as overdose rates soared over ensuing years, doctors realized too late that the drugs were, in fact, highly addictive. By 2015, two million people in the United States suffered from substance use disorders related to prescription opioid painkillers. And by 2016, there were more than 63,600 drug overdose deaths in the United States.

“Doctor shopping” is a widespread practice which contributes to the large numbers of opioids in circulation. By visiting multiple doctors, patients obtain multiple prescriptions for controlled substances without setting off red flags with any one practitioner. Thus, doctors often become unwitting drug dealers to their addicted patients.

In a recent article for The New York Times Magazine, doctor and author Siddhartha Mukherjee recounts his early struggles with a patient. Mukherjee’s patient initially came in seeking medication for her frequent headaches. Over the next twelve months, her addiction took hold and her attempts to get painkillers “distorted [the alliance between patient and doctor]”.

Mukherjee increasingly felt at odds with his patient. He writes, “The doctor shifts from healer to dealer. To the addict, the doctor is contorting the truth; to the doctor, it’s the addict who is constantly inverting reality. The doctor is, at first, the enabler and the supplier, and then the tormentor, the withholder, the liar, the enemy.”

Eventually, Mukherjee cut off his patient. Later, he found out that multiple ER doctors and clinics had refused to prescribe her the drugs as well. Tragically, because her doctors were not able to notify and warn each other of her attempts, the patient died of an overdose.

Improving Interoperability Could Help

As always, there is a consistent effort as a nation to help those addicted to any kind of drugs to become clean, from the opening of rehabilitation centres to the growth of online resources like https://420highstreet.org which offers advice on how to cleanse your system. When it comes to the specific problem of doctor hopping, the creation of Prescription Drug Monitoring Programs (PDMPs) is a new method. PDMPs are databases developed by individual states to track and monitor prescriptions for controlled substances.

Yet, statewide PDMPs on their own may not be enough. Some states have systems which are not fully operational, while others do not require that doctors check PDMPs before prescribing. Thus, patients could still doctor shop across state lines. Additionally, the user experience with PDMPs can be cumbersome. Since PDMPs do not connect seamlessly with a patient’s electronic health record (EHR), the information can be difficult to view within the context of patient’s health history. This can discourage doctors from using them if they have to switch back and forth between multiple systems, interrupting their workflow and reducing valuable face-to-face time with patients.

This is why CHIME, a leading association of healthcare IT leaders, recommends that federal agencies improve the way these systems connect and talk with one another. “Today, oftentimes the information offered to a clinician in a PDMP is presented in a disjointed manner, requiring the prescriber to take additional steps to review past scripts from other healthcare providers,” CHIME states. “This creates a fragmented picture for clinicians and results in data that is not integrated seamlessly within an EHR.”

In other words, if the systems are not being used as intended, it’s harder for medical practitioners to identify patterns and potential indicators of drug abuse. But, doctors could make more informed decisions if state PDMP databases connected with EHRs and clinical decision support tools. By seeing a patient’s history holistically, practitioners could better determine whether it is appropriate to prescribe opioids.

What Asymmetrik is doing

Asymmetrik supports the fight against the opioid crisis along several fronts. We’ve recently joined Health IT NOW (HITN), a leading coalition of the nation’s most powerful names in technology and healthcare. Their goal is to deploy technology to improve the quality of healthcare and lower costs. This includes their Opioid Safety Alliance, which advocates using technology to fight illegitimate opioid use, abuse, and addiction.

Asymmetrik’s interoperability solutions, including our open source HL7® FHIR®-Extensible API Framework for Healthcare, improve treatment workflows and EHR integrations for providers. By linking the systems together, we’re helping medical practitioners make better informed decisions. Our solutions also offer data collection and analysis for evidence-based treatment, which can help hospitals improve care quality for entire populations. Together, with the healthcare community, we’re working towards better outcomes supported by better technology.