Members in Action Case Study: A Multi-Pronged Approach to the Opioid Crisis

Overview

Catholic Medical Center (CMC) is a 330-bed, not-forprofit, full-service acute care hospital in Manchester, N.H. The hospital offers medical-surgical care with more than 26 subspecialties, inpatient and outpatient services, diagnostic imaging and a 30-bed 24-hour emergency department (ED). Norris Cotton Cancer Center at CMC offers medical oncology and infusion services, and the New England Heart and Vascular Institute provides advanced cardiology and cardiac surgery services to the region.

In New Hampshire, drug overdoses have surpassed motor vehicle crashes as a cause of death. About 80 percent of those who use illicit street drugs such as heroin began by misusing prescription opioids, whether they were prescribed to themselves or obtained from a friend, relative or dealer. As opioids have taken a grip on the state, hospitals have been inundated with patients suffering from addiction. In EDs alone last year, 6,000 patients struggled with opioid addiction, with more than 1,000 being treated at CMC. Those patients are mostly in their 20s and 30s but range from newborns to the elderly.

CMC has responded aggressively to this opioid epidemic by providing the hospital’s medical staff with tools to cope with the influx of patients suffering from Substance use Disorder (SUD). These tools include embedding the New Hampshire Prescription Drug Monitoring Program (PDMP) in the hospital’s EMR to identify patient prescription patterns that might indicate an addition; informing patients of the hospital’s pain treatment policy; increasing provider education on substance misuse; partnering with pre-hospital and post-hospital resources; and organizing a continuing medical education program that evolved into an annual Summit on Substance Misuse and Pain Management, which attracts health care professionals including physicians, surgeons, pharmacists, nurses, social workers, first responders, and others so that they can stay abreast of this rapidly evolving opioid epidemic from all over the state.

To help prescribers embrace the state’s new opioid prescribing rules, they were given background information detailing how opioid prescriptions can lead to excess pills being available for misuse and diversion. For example, it was shared that in New Hampshire during June 2016, based on data from the PDMP, approximately 4.9 million opioid tablets were prescribed to New Hampshire residents, which is approximately 10 pills per household during just that single month. Early on, to inform patients visiting the CMC ED, patient education posters were mounted in the ED to inform patients that lost opioid prescriptions will not be replaced, opioid pain relievers are used as a last resort therapy, long-acting opioids will not be started in the ED, and contact information for addiction service is provided.