Leading on Opioids

Good morning!

Before I begin I want to take a moment to put in a plug for the Sanderson Farms Championship golf tournament currently underway at the Country Club of Jackson.  The tournament, which has its own date on the PGA TOUR schedule for the first time this year, is a major entertainment and economic asset to the Jackson metro area and to the state.  More than that, Sanderson Farms CEO Joe Sanderson and his wife, Kathy, are wonderful friends to the Medical Center, leading our fundraising effort for the Children’s of Mississippi expansion. We’re all very busy, but if you get the itch to see golf played on its highest level, scratch it with a visit to the Sanderson Farms Championship.

Today I’d like to highlight a growing and alarming issue that medical centers such as ours grapple with every day. Opioid addiction in 2018, the most recent year for which data are available, claimed at least 208 lives in our state – and those are just the suspected overdoses reported to the Mississippi Bureau of Narcotics.

Nearly half of all opioid overdose deaths in the state involve a prescribed opioid, data from the Mississippi State Department of Health show.  And the latest figures from the National Institute on Drug Abuse indicate that, in 2017, Mississippi providers wrote 92.9 opioid prescriptions for every 100 residents, compared to the average U.S. rate of 58.7 prescriptions.  That’s an astounding number of prescriptions!

Needless to say, there’s a critical need for accountability, not just for patients taking opioids, but for providers who make those narcotics available.  The Medical Center has a huge responsibility to take the necessary steps to give providers the tools they need to take a more even-handed approach to opioid prescribing while delivering individualized care for every patient. And we are embracing that responsibility.

The Medical Center’s Opioid Task Force, which was created in June 2018, encourages providers to have conversations with each other on whether their patients’ illnesses require opioids, or in the alternative, non-opioid medications or non-medication therapy.  The task force is revising UMMC’s controlled substance policy to incorporate not only national guidelines, but also new rules put forth by the Mississippi State Board of Medical Licensure.

Medical Center providers are using the Mississippi Prescription Monitoring Program, an electronic tracking process managed by the Mississippi Board of Pharmacy, to help practitioners and pharmaceutical dispensers identify possible inappropriate use of controlled substance drugs and other designated medications.

Dr. Ann Kemp, professor of family medicine, chairs our task force in partnership with its co-chair, Dr. William Gusa, assistant professor of anesthesiology.  The panel’s work goes beyond the state requirements and takes a more comprehensive, in-house approach to finding solutions.

A few examples:

• Drug tests administered by Medical Center providers also screen for several other hard-to-detect compounds such as Fentanyl, an opioid up to 100 times more powerful than morphine. UMMC’s toxicology laboratory, led by Dr. Patrick Kyle, professor of pathology, works with physicians on the task force to develop customized test panels for pain management patients.  The tests verify that patients are using their medications as prescribed and aren’t taking illegal drugs or other people’s prescription medications.
  
  
• Patients in the Emergency Department who show signs of opioid withdrawal can start their recovery process immediately when ED staff connect them to UMMC’s addictions services team, staffed by members of the Department of Psychiatry and Human Behavior. Those providers also treat patients with alcohol use disorders.
  
  
• If any UMMC provider is concerned that a patient is developing, or has developed, a substance use disorder of any kind, the provider is encouraged to consult with the addiction services team. The solutions could include medication-assisted treatment, which calls for giving the appropriate patients drugs that reduce cravings for opioids and prevent addicts from getting high if they relapse.
  
  
• Task force members are providing lectures and continuing education on appropriate opioid use, prescribing and drug testing.

UMMC is on the forefront of the issue, taking part in an initiative to improve chronic pain care and put into action Centers for Disease Control and Prevention recommendations for opioid prescribing.  Under the guidance of Dr. Shannon Pittman, chair of the Department of Family Medicine, the department is collecting data to determine how well it is meeting five of the CDC’s guidelines on opioid prescribing.

As part of that program, family medicine providers are using a new tool in the Epic health record that reminds them to meet and check certain criteria, such as administration of a urine test before the start of opioid therapy. That’s not just to confirm a patient’s prescribed medications, but to detect controlled prescription drugs and illicit street drugs.

The initiative allows family medicine providers to set an example for other departments and to do the best they can for their patients.  That might mean identifying gaps in their care, or giving them, if appropriate, the rescue drug Narcan to treat narcotic overdose in emergency situations.

Our providers and researchers lend their expertise to the “front lines” in opioid law enforcement.  Our toxicology lab uses sophisticated equipment and testing methods to scrutinize blood and urine samples in addition to samples of illegal "designer" opioids and prescription medicines.  Their work helps identify which dangerous street drugs are making the rounds in the state and what trends to expect in the future.

The work of our Opioid Task Force continues with the goal of providing a consistent message: Be cautious about opioid and controlled substance prescribing, but have a balanced approach and give patient-centered care.  This is not a ban on prescribing opioids by any means; instead, it’s doing the best by our patients as we all work together to achieve A Healthier Mississippi.