Becker's Clinical Quality & Infection Control

55 OPIOIDS Dr. Toby Cosgrove: Opioid epidemic has 'peaked' By Harrison Cook T oby Cosgrove, MD, former president and CEO of Cleveland Clinic, discussed America's efforts to combat the opioid epidemic during an Aug. 13 episode of CNBC's program the "Squawk Box," saying he believes the crisis has "peaked." "We're starting to see the understanding of the prob- lem," he said. "[We] are getting to the point where people are certainly prescribing fewer drugs and people are recognizing how serious this is." Despite these improvements, Dr. Cosgrove said opioids still pose major health risks for citizens, citing the prevalence of drugs being laced with synthetic opioids, such as fentanyl or carfentanil. "Carfentanil is 10,000 times as potent as morphine. These drugs are getting laced," Dr. Cosgrove told CNBC. "We just had an outbreak of deaths in Ohio from drugs being laced with very potent carfentanil and fentanyl." In 2016, there were 42,000 opioid overdose deaths reported in the U.S., according to the CDC. n Physicians prescribe fewer opioids after county medical examiner notifies them of patients' fatal overdose By Harrison Cook T o overcome the disconnect between clinicians prescribing opioids and patients dying from opioid overdoses, researchers at Los Angeles-based University of Southern California aim to make the opioid epidemic more personal for physicians, according to a study published Aug. 10 in Science. Researchers conducted a randomized trial between July 2015 and June 2016 of 861 clinicians in San Diego County who previously prescribed opioids to 170 patients who suffered a fatal overdose. Half of the clinicians received a letter from the county medical examiner saying a patient they'd prescribed opioids to within the last 12 months died. The letter also included information from the CDC on safe prescribing guidelines. "Clinicians may never know a patient they pre- scribed opioids to suffered a fatal overdose. What we wanted to evaluate is whether closing that information gap will make them more judicious prescribers," Jason Doctor, PhD, director of Health Informatics at the USC Schaeffer Center for Health Policy & Economics and associate professor at the Price School of Public Policy at USC. Opioid prescribing decreased 9.7 percent after three months among physicians who received the letter, compared to the control group. Clinicians receiving the letter were 7 percent less likely to start a new patient on opioid treatment and were less likely to prescribe higher opioid doses. "Interventions that use behavioral insights to nudge clinicians to correct course are powerful, low-cost tools because they maintain the autonomy of the physician to ultimately decide the best course of care for their patient," Dr. Doctor said. "In this case, we know opioids, though beneficial to some patients with certain condi- tions, come with high risks that the [physician] may not fully grasp when observing patients in the clinic. Pro- viding information about harm that would otherwise go unseen by them gives physicians a clearer picture." n EMS naloxone use jumps 75% in 4 years, CDC says By Harrison Cook E mergency medical services' use of naloxone has increased significantly amid the ongoing opioid epidemic, according to research published Aug. 10 in the CDC's Morbidity and Mortality Weekly Report. Here are three things to know: 1. CDC researchers analyzed the rate of EMS naloxone adminis- tration events from 2012-16 using data from the National Emer- gency Medical Services Information System. ey also examined mortality rates linked to opioid overdoses over the same period using the National Vital Statistics System database. 2. e rate of EMS naloxone administration increased from 573.6 administrations per 100,000 EMS events in 2012 to 1,004.4 per 100,000 in 2016, marking a 75.1 percent increase. is mir- rors the 79.7 percent increase in opioid overdose mortality seen during the study period, which jumped from 7.4 deaths to 13.3 deaths per 100,000 people. 3. e age distribution of patients who received naloxone from EMS resembled a similar distribution for mortality, with individ- uals between ages 25-34 years and 45-54 years most affected. n

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