VCU and Other Virginia Hospitals See Opioid Death Decline
By: Katja Timm
Virginia hospitals are monitoring painkiller prescriptions more closely and taking other steps to curb the opioid epidemic, and the efforts may be paying off: Drug overdoses in Virginia have dropped for the first time in six years.
In 2016, the opioid epidemic was declared a public health emergency in Virginia. Fatal opioid overdoses increased steadily from 572 in 2012 to 1,230 in 2017. Last year, however, the number of deaths dipped to 1,213, according to preliminary statistics released Tuesday by the Virginia Department of Health.
The decrease coincided with data from the U.S. Centers for Disease Control and Prevention showing a decline in overall prescriptions of opioids in recent years – and with moves by Virginia officials and physicians to apply more scrutiny before issuing such prescriptions.
Dr. Charles Frazier, senior vice president at Riverside Health System in Newport News, said his medical practice and others across Virginia are prescribing narcotics in a more controlled and efficient way.
Frazier was involved in the creation of Virginia’s Emergency Department Care Coordination program. Established by the General Assembly in 2017, the EDCC’s purpose is to “provide a single, statewide technology solution that connects all hospital emergency departments in the Commonwealth” for the purpose of extending and improving patient care, according to ConnectVirginia, a statewide health information exchange.
Virginia’s Prescription Monitoring Program
Gov. Ralph Northam, a physician himself, helped create the EDCC. He also has been an advocate for the state’s Prescription Monitoring Program.
Under that program, Frazier explained, “Every time a pharmacy prescribes a controlled substance, they need to submit the information to the state – the duration, the dosage, how many times and how many providers have prescribed to them.”
The Prescription Monitoring Program also requires seeing patients every 90 days and conducting drug screens to make sure patients are taking their medications. Moreover, the program screens patients for depression and advises them how to avoid developing a dependence on a substance.
“If you’re treating someone with higher dosages, it gives them preventative measures for overdose,” Frazier said.
Patients can self-administer pain relief
Besides participating in the Emergency Department Care Coordination program, VCU Medical Center Hospitals have a specific technique allowing patients to self-administer drugs.
Samantha Morris, a care partner at the VCU Medical Center’s Emergency Department, said narcotics can be administered directly to a patient, by the patient, with the press of a button. This involves a device called a patient-controlled analgesia pump.
“Fentanyl is usually what I see being prescribed the most, and that one is usually administered through a PCA pump,” Morris said. “It delivers some form of narcotic, usually fentanyl, and the patient presses a button to administer themselves a dose every five to ten minutes, depending on the drug.”
The amount of time a dosage from the PCA pump can be administered is based on the strength of the drug prescribed.
“I see patients mostly in the burn victim unit because they’re in a lot of pain,” Morris said.
Morris said she sees patients come in for opioid-related incidents all the time.
“It’s really difficult, because if a patient is addicted to any kind of substances, whether it’s amphetamines or any kind of narcotic to begin with, we can’t administer pain management, because it’s not going to affect the same pathway.”
Morris explained that when taking opioids while harboring a previous addiction, the drug binds to an addicted person’s dopamine receptors. This is what gives the “pleasure feeling” and “euphoria” of taking the drug on a regular basis.
Opioid overdose fatalities decline
Health officials’ concerns about opioids have grown as fatal overdoses spiked over the past decade. Preliminary numbers show that 1,484 people died from drug overdoses in Virginia in 2018. That is more deaths than from guns (1,036) or traffic accidents (958).
The total number of overdose fatalities was down slightly from 1,536 in 2017.
The vast majority of drug overdose deaths involve opioids. Of the 1,230 opioid-related fatalities last year, about 460 involved prescription medications and the rest involved heroin and/or fentanyl.
The number of prescription opioid deaths dropped from 507 in 2017 to 457 last year. On the other hand, deaths from heroin and/or fentanyl jumped from 940 to 977.
New controls on opioid prescriptions
Frazier said the biggest impact on the opioid epidemic may stem from rules imposed last year by the Virginia Board of Medicine.