America's biggest drug problem isn't on the street—it's in our medicine cabinets. In fact, prescription drug abuse is the leading cause of accidental death in the U.S. today. In 2016, more than 46 people died every single day from overdoses involving prescription opioids such as methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).
Prescription opioids are typically used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer. Although critical to patient care, the misuse and abuse of prescription opioids has led to a serious nationwide epidemic.
1 in 4 patients receiving long-term prescription opioid therapy in a primary care setting struggle with opioid addiction.
From 2000 to 2016, more than 600,000 people died from drug overdoses.
40 percent of all opioid overdose deaths involve a prescription opioid.
Fortunately, Quantum Health nurses and Personal Care Guides (PCGs) have the opportunity to intercept our members IN REAL TIME when guidance is critical.
In December of 2015, one of our members, Kay, had knee replacement surgery. Kay's surgeon prescribed her an opioid to help with the post-op pain she was experiencing. Unfortunately, complications arose from her surgery, necessitating a surgical revision that was scheduled for May of 2016. Kay continued on the prescription opioid during those six months while awaiting her upcoming surgical procedure.
After her surgery, Kay began physical therapy. By July, she was no longer in pain and tried to wean herself off the medication. Without the drug she had been so dependent upon for the past eight months, she became violently ill and felt as though she was dying. Her greatest fear had become a reality—she was addicted. Several years ago, Kay's brother ended up addicted to pain killers after his own surgery. He was admitted to a treatment program where he was given Suboxone to treat his opioid dependency. He is still on this medication today. This terrified Kay because she did NOT want to be following in her brother's footsteps.
Being a nurse herself, Kay realized she was in withdrawal and called her surgeon, requesting his help. For reasons unknown, he refused. After her third attempt to contact him, he stopped taking her calls.
Feeling helpless and scared, Kay called her PCG at Quantum Health, Jill. She told Jill she wanted to go to an inpatient detox center. Jill researched Kay's benefits and connected with New Directions—the company that administered Kay's behavioral health/substance abuse benefits. Jill worked with the New Directions team to find an in-network addiction/detox center for Kay, but no one would take her. Upset and crying, Jill assured Kay that she would find a resolution—and fast.
Jill contacted Kay's Primary Care Physician (PCP) who agreed to put Kay on a plan that would safely wean her off her medication while preventing any symptoms of withdrawal. Kay was happy with the plan and by September of 2016, she was completely off her medication—symptom-free.
This is just one example of how people can find themselves caught in the healthcare system that can leave them feeling completely helpless, not knowing where to turn. This could have ended very badly for Kay. Had she not called her PCG, she may have just remained on the medication for as long as she could find someone to prescribe it, even though she no longer needed it for pain management. If she couldn't find someone to fill it, there's a chance she could have taken much more desperate measures.
Kay's story is all too familiar. But, at Quantum Health, we make sure our members understand their doctor's plan for pain management post-surgery. Many people don't want to take a prescribed opioid for pain because they're scared they will become addicted to it. But the fact of the matter is, if a member is experiencing pain, he/she NEEDS to take the medication. We help by working with the member on the right questions to ask their provider prior to surgery. We provide distraction techniques such as guided imagery, where members are encouraged to close their eyes, picture themselves at their favorite vacation spot and focus on their breathing. We thoroughly go over post-discharge instructions. We talk about what happens if they have breakthrough pain and how they should handle it (such as ensuring bandages are wrapped appropriately to provide compression). And, we make certain they know when and how to take their medications.
Today, pharmacies and PBMs are cracking down on just how many opioid prescriptions they can prescribe. But, until stricter procedures are in place, a greater emphasis on education occurs and alternatives for pain management are discovered, Quantum Health PCGs will continue to work with at-risk members to help them avoid or overcome addition.