Article contributed by Carla Smith, Executive Vice President of The Healthcare Information and Management Systems Society (HIMMS) for PharmaBoardroom.
Today more Canadians are dying in this crisis than at the height of the HIV epidemic.
Recognizing that we need to join forces to fight the opioid epidemics in both our nations, Canadians and Americans are connecting in a collaborative effort that will strengthen our ability to reverse the rising levels of Canadian and American opioid-related deaths and disorders, and present opportunities for other nations to learn from our experiences.
The story is similar in the US where, in 2016, 66% of drug overdose deaths were opioid-related, and opioid-related death rates increased 21.5% in one year. According to the US Centers for Disease Control, three inter-connected sources currently driving the epidemic have distinct times of origin:
- The 1990s to today: an increase in deaths from prescription opioid overdoses
- 2010 onset: an increase in heroin deaths
- 2013 onset: surge in deaths, particularly among males, and people aged 15-44 years, from illicitly manufactured fentanyl, and fentanyl analogues. (Relatedly, in 2017 in Canada, 69% of opioid-related deaths were people aged 20-49, and 76% of the deaths across all age groups were males.)
The highest rates of Canadian opioid-related deaths occur in British Columbia, Ontario, and Alberta, while the US suffers most in West Virginia, Ohio, and New Hampshire. In both nations, prescription opioids continue to be involved in a significant proportion of drug overdose deaths. Furthermore, the numbers likely underestimate the true burden of prescription opioids. In the US, for example, a large percentage of death certificates for overdose victims do not list the type of drug. Medical examiners performing autopsies operate in a myriad of jurisdictions, with little standardization regarding which substances are being tested for, and the circumstances under which toxicology tests are performed.
What we do know is that the epidemic is shifting, again. In 2016, there were more deaths reported in the US from synthetic opioids than any other opioid, while Canada’s data shows a similar trajectory – an upsurge in deaths from fentanyl. Death rates in both Canada and the US are increasing due to residents combining opioids with non-opioid meds such as benzodiazepines.
So, what can we do?
Well, a lot. Let’s start with the front-line care providers. In the United States alone in 2016, 84.6% of adults (that’s 232 million adults) sought care from a health professional. This presents us with a powerful opportunity to equip our dedicated physicians, nurses, and pharmacists in all nations with the up-to-date knowledge required to identify the non-medical use of prescription opioids, and warning signs emanating from escalating requests for out-of-sequence refills or higher dosages. That information must be electronically interoperable, highly-credible, and provided to health workers in ways that fit into their workflows and makes sense to their patients.
We need coordinated action of team-based care, health information interoperability, law enforcement, and policy/payment reform. Note that five of the six states most badly affected by the crisis sit on the US-Canadian border. This further echoes that in order to stop this epidemic, we must work together.
We have numerous tools available to strike a balance between restricting prescribing to prevent abuse with prescribing opioids in appropriate pain management care plans. For instance, prescription drug monitoring programs (PDMPs), are state-based repositories of pharmacy data pertaining to the prescribing and dispensing of controlled drugs, as well as preventing and identifying prescription drug misuse. There is an opportunity to ensure that all stakeholders at community, region, state, national, and cross-border levels – have access to actionable reports.
And, to make those reports accessible and actionable, we must have ubiquitous, secure, interoperable health information. Fortunately, there are many examples of initiatives working to create such a reality. At the policy level, the US Centers for Medicare & Medicaid Services (CMS) has encouraged States to use existing federal funding to create interoperability between care providers and PDMPs. For behavioural health professionals, many of whom do not have electronic health records, CMS has encouraged States to consider app-based technologies.
In Canada, the Canadian Mental Health Association’s 2018 report on opioid policy calls for the integration of mental health and addiction services into the full continuum of care – acute, outpatient, counselling, and community-based care and support. With 86 branches, regions, and divisions in 330 communities across Canada, this will require fully interoperable technology in which all workers will need to receive training.
Opportunely, the Canadian government launched an innovation competition in which it will award funding to enable large-scale projects applying data capabilities in the health and biosciences sector. And, there is an exciting new 5-year, $300M initiative on the part of the Canadian government to expand e-prescribing and virtual care. Both will be potent tools to apply to this crisis. If ever there was a perfect alignment of a critical need of a nation, combined with funding opportunities such as these, it is now.
Cross-Border Health is focused on improving health and healthcare by leveraging Canada and the United States’ close, continuing relationship in all sectors.
Follow Carla on Twitter @CarlaMSmith