Drug overdoses have increased rapidly in the United States over the past two decades and is a leading cause of injury or death among people. Drug overdose can happen to people of all age groups and demographic characteristics and include overdose of illicit opioids such as heroin, prescription opioid, and analgesics like methadone, hydrocodone, fentanyl and oxycodone.
As per reports from the Centers for Disease Control and Prevention (CDC), about 41,502 drug poisoning deaths were reported in the US in 2012. Out of this, about 22,114 (53%) were related to pharmaceuticals. It is estimated that every day about 114 people die as a result of over dosage and more than 6,748 are treated in the emergency departments for the misuse of medicines. About 9 out of 10 poisoning deaths are mainly caused by medicines – both illicit and prescribed. Drug overdose can occur due to a wide variety of factors which are mentioned below –
- When a person misuses the physician prescription opiate or an illicit drug such as heroin
- When a person consumes the medicine as directed by the physician but the prescriber miscalculates the dosage
- If the dispensing pharmacist makes a mistake or the patient wrongly understands the directions for usage of medicines
- If a person consumes medications prescribed for someone else
- If a person combines opioids (prescribed or illicit) with alcohol or other medicines or even some over-the-counter products that may lower breathing, heart rate and other functions of the central nervous system
Physicians Can Help Prevent Drug Overdose
Physicians and healthcare providers can help reduce the potential risk of overdose cases by giving more attention when prescribing medications and carefully monitoring the patient’s response in identifying and addressing the case of over dosage.
State Prescription Drug monitoring Programs (PDMP) have also emerged as an effective approach for preventing the problem of prescription drug misuse. This program allows prescribers to check in their PDMP database and verify whether a patient is filling the prescriptions provided and obtaining the correct prescriptions for the same or similar medicine from multiple physicians.
Physicians should take special precautions while treating new patients. When deciding to prescribe opium, physicians need to conduct a complete assessment about the patient history of current medication and alcohol use. This patient assessment may include types of tablets used, quantity and frequency of use, symptoms of dependence, route of administration, prescribed medications, alcohol or tobacco use and their dependence symptoms.
Patients with histories of substance use disorder or mental health problems should receive special attention from pain management specialists. Physicians need to determine the correct dosage, schedule and formulation while prescribing medications. Medication-assisted treatment, along with counseling and other supportive services may help drug overdose survivors lead a healthier life. In addition, regular follow-ups at least once in 2-3 months may help to avoid further risks.
Providers need to keep their knowledge updated about evidence-based practices for the use of opioid analgesics to better manage pain and prevent steps to reduce overdose. Moreover, they need to adhere to the specific regulations of the federal government and other agencies regarding the medical billing and coding changes. It is crucial that healthcare practices document medical necessity correctly by reporting the services and treatments offered. In order to submit accurate medical claims, physicians should have essential billing and coding know-how and should use the correct diagnostic and procedural codes to ensure correct and timely reimbursement. 965.09 is the ICD-9 code to report screening for poisoning by other opiates and related narcotics.
Prescription Opioids Involved in Most Overdoses in Emergency Departments
A new study published online by JAMA Internal Medicine reports that, prescription opioid medications are involved in more than two thirds of emergency department admissions due to overdoses. The national study of hospital emergency department visits for opiate overdoses found that about 67.8 % of the same were due to prescription opioids including methadone, heroine and other unspecified and multiple narcotics. With medication overdoses been cited as a leading cause of injury-related mortality in the United States, very limited information is known about how opioid overdoses are present in the emergency departments (EDs).
As part of the study, researchers analyzed the 2010 Nationwide Emergency Department Sample with diagnostic codes for overdose. They identified 135,971 weighted ED visits that were coded for overdose. The key findings of the study are mentioned below –
- 67.8 % of high doses were due to prescription opioids (including methadone), while 16.1% involved heroin, 13.4% involved unspecified and 2.7% involved multiple opioid types.
- Researchers found geographical variations in overdose patterns with a higher proportion (84.1 %) happening in urban areas, in the South 40.2% and among women 53%. In fact, most patients who suffered over dosage had health insurance coverage.
- Many patient cases shared common co-morbidities which included chronic mental health problems (33.9%), circulatory diseases (29.1%) and respiratory (25.6%) diseases. Hence, healthcare providers who prescribe opium medications to patients (suffering from these pre-existing conditions) should take extra care in doing so and should counsel the patients about the potential risks of associated with consuming these medicines.
- “Co-intoxication with benzodiazepines” was visible in 22% of patients. This figure indicates the need for careful prescription in conjunction with other sedating medications.
Even though the proportion of patient visits in the emergency departments that resulted in death was highest for overdoses, the overall patient death rate was low (1.4%). This finding supports the need to put in more efforts to expand access and utilization of emergency medical services for high dosages. More than half (50.6%) of overdose patients who visited the EDs were admitted to the hospital and the total costs for both inpatient and ED charges were up to 2.3 billion.
As part of the study, researchers found critical geographical and clinical variations among high dose patients visiting the EDs and this has prominent implications for overdose prevention and response interventions. The study results signify the need to take serious efforts at the local, state and national levels to address the opioid overdose epidemic. More resources should be directed to increase access to naloxone (the antidote for opiate high dose), and promote safe prescribing practices among clinicians. In addition, more awareness about the potential risks of overdose must be spread among patients who regularly use prescription and non-prescription opioids.
