Can Death Diaries Help the Opioid Crisis

Drug: a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body. Man has been using plants and food as drugs since the beginning of time to his benefit as well as detriment.

In past columns I have written about the unconscionable actions of “big pharma” and specifically Purdue Pharma. Starting in 1996, they lied to the public, including physicians about the addictive properties of their products.

In 2018 one would be hard-pressed to say they don’t know the danger of opioids and their addictive properties. Yet, as we completed open enrollment for Medicare Part D Rx plans, I was amazed at the number of clients with drug lists that included large doses of oxycodone, fentanyl and the like.

Health and drug plans are becoming more restrictive on the use of these drugs, requiring prior authorizations and more “hoop jumping” before they will pay for these medications. This has left some disgruntled patients as well as doctors. The patient response is typically that those addicts are “someone else”. Physicians complain that they don’t have the time to deal with this “second guessing” by insurance companies.

CMS (Center for Medicare & Medicaid Services) recently released a proposal to set new tighter limits through “hard formulary levels”. Overrides require plan consultation with the treating physician. Initial Rx for acute pain could be limited to 7 days. We often see health plans follow CMS guidelines, so expect to see more of this.

I was intrigued to read about a project called “Death Diaries” conducted by Dr. Roneet Lev, the head of Emergency Medicine at Scripps Mercy Hospital. According to an article in the San Diego Union-Tribute, she collected the following information from Coroners records for overdose deaths: name, age and a list of the prescription drugs they overdosed on, followed by a yearlong history of the deceased’s medications, the doctors who prescribed them and the pharmacies that filled them. Nothing more.

As she reviewed the data she found disturbing patterns that led her to believe many of these deaths were preventable. She suspected most of the physicians had no idea of their role in the death and decided to extend the project by sending letters to each of the doctors, notifying them that their patient had died.

She also suspected that a striking number of physicians were not using or not properly using the Controlled Substance Utilization Review and Evaluation System, or CURES database. Doctors are encouraged to check this data base before prescribing a new drug to a patient to be sure the patient hasn’t “forgotten” a medication they are using.

One could argue this is one more annoyance to an overly stretched physician’s day. But on the other hand, is it not a gift that we have this type of resource?

Dr. Lev shared a personal experience from the ER. A clean-cut, well-dressed man requested she fill a small prescription for Ambien- a sleep inducing drug. His said he was leaving on a trip and could not reach his own doctor.

Her check of CURES showed 17 doctors and 42 prescriptions in the past year. Seventy-five Ambien pills had already been filled that month — by five different doctors.

She declined to fill the prescription and counseled him about his apparent problem. He did not respond. Dr. Lev put a note in the CURES messaging system to the 17 doctors alerting them to her concerns. There is no way to alert doctors that a message is waiting for them. They have to sign into CURES to see it. Great tool, but clearly missing some functionality.

I wonder about the response of physicians to letters about their patients’ deaths. Would it be like that of a local orthopedic surgeon when he was advised by a local nurse that her son had become addicted to opioids following his surgery? Rather than examine his part in the process, the doctor said, “Had I known he was an addict, I would never had agreed to take him on as a patient”. The young man eventually died of a heroin overdose. Has that doctor since reviewed his post-surgical prescribing patterns?

Dr. Lev’s research into the records also showed that often the deceased patient had misused their prescriptions and/or had illicit substances in their bodies as well. Clearly this is a complicated issue and will require a multi-faceted solution.

There is a local group called NoRxAbuse that seeks to bring together players from law enforcement, social programs and medical providers to help address these issues from multiple fronts. One major task is to contact physicians to try to educate them about their prescribing patterns as well as alternate treatments. It’s a start.

Margaret R. Beck
Margaret Beck  CLU, ChFC, CEBS started her insurance practice in Redding in 1978. As an insurance broker/consultant,  she represents businesses and individuals as their advocate.  She assists in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies. Questions to be answered in this column can be submitted to info@insuranceredding.com. Beck's column is also published in the Redding Record Searchlight.
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10 Responses

  1. Beverly Stafford says:

    Unless dark chocolate counts, I don’t understand addiction. Obviously after surgery or an injury, medication for pain is a necessity. Many among us seem to think we need to feel absolutely great all the time. Where did that come from?

  2. Patricia Bay says:

    This is a powerful problem with far reaching effects into health, family functioning and all relationships. This is a timely article, Marge. Well done!

  3. AJ says:

    Thank you Marge . . . . Such important information. It needs to be out there for all to see, especially the medical community. Failing to utilize the information available is no excuse when compared to the loss of a life.

  4. K. Beck says:

    I ended up in Shasta Regional for a heart problem. Three days in the hospital for “observation.” Luckily I was alert the whole time. Background: the EMS folks took me to the hospital. In route, they asked me if I was in pain. The pain was so slight I didn’t realize there was any pain. After they asked me I said I did have a sharp needle like pain in my left shoulder joint. It was extremely minor pain. They immediately gave me a “spray” of nitroglycerin under my tongue. The resulting head ache was far worse than the pain in my joint. As they were rolling me into the ER they asked me that again, in fact the pain was shooting across my sternum through that same joint. Again it was very slight pain. Some more nitroglycerin. NO ONE in the ER asked me about pain, not even the Cardiologist, yet everyday the nurse would bring in a handful of pills. One was always for pain, which I did not have. I asked her every time to go through the pills one by one and tell me what they were. NO ONE asked me about pain. I kept refusing to take the pain pill. I kept wondering where all those pain pills ended up.

  5. Common Sense says:

    There is an Alternative to Pain Med’s.

    Its been lied about…stigmatized for 70+ years. When one does their own research after moving through their “Cognitive Dissonance” on the topic….they realize the truth about Cannabis.

    The RX companies have fought for many many years to keep this plant and its benefits away from the public…just too much money to be made with the Synthetic Poisons they create. The RX industry is a $550Billion Dollar cash machine.

    https://www.entrepreneur.com/article/308174

    Every Wonder WHY the Government has a Patent on the Medical Benefits of the Cannabis Plant? Patent No. 6,630,507

    Interesting that it helps with PAIN. Interesting Fact.

    The Score on the Pain Med’s- Opioid pain relievers were involved in 16,917 overdose deaths in 2011.

    Cannabis Deaths total to date= ZERO

    So why is it that the Government…..that is supposed to be For the People….has not Legalized this natural plant across the board??…Oh….that’s right…..follow the Money!

  6. Hollis Pickett says:

    Thank you for making the attempt to keep this issue on everyone’s radar! You say at the beginning of your article that surely everyone knows the dangers of opioids by now – makes me think of cigarettes, right? I would add one thing to your narrative. The addiction of that individual, the money they beg, borrow or steal to get drugs, the devastating effect on their family and friends – thats only part of the story. Some of you may remember the series of articles that ran here some years ago about chronic viral hepatitis (“Your Liver, Your Health”). Those articles ran before the opioid crisis loomed so large. We were (in retrospect, naively) thinking that we could conquer Hep C (HCV) because new “miracle” drugs were on the horizon. Well, those drugs are here……along with thousands of new HCV and HIV infections caused by IV drug use. At least there are still vastly improved HCV drugs available to addicts who can kick their habit. And I’ll go further in slamming big pharma. The same companies that produce many of the opioids also produce NARCAN – the emergency drug EMT’s and police can use to save someone’s life in an overdose situation. Awesome.

  7. Richard Christoph says:

    Thanks for this fascinating and informative article, Marge.

    From the age of 6, all of us school kids were inculcated with the pitfalls and dangers of hard street drugs, and the tales and video of heroin addicts living in squalor and going through withdrawals remains fresh more than 60 years later. The willing surrender of autonomy to an illegal substance, associated aberrant behavior, and the profound unpleasantness of withdrawal made a profound impression. Seems as though a concerted emphasis on prevention would be far more cost effective than the extraordinarily expensive and limited treatment options that often promise more than can be delivered.

    Given the well-documented connection between injuries sustained in extreme sports and subsequent opioid addiction, one wonders whether the current Winter Olympics, the X Games, and other high-risk athletic pursuits may inadvertently be contributing to the future addiction of some of the successful athletes, as well as the many would-be participants who did not make the team.

  8. Common Sense says:

    It’s not an easy fix, the Opioid Problem. Here is what a panel of Experts and people in the Field would do to fix the problem.

    https://www.nytimes.com/interactive/2018/02/14/upshot/opioid-crisis-solutions.html

  9. Common Sense says:

    Fentanyl, the drug that Killed Price….rising in the charts of the Devils Drugs. Shasta County is actually doing better than Many County’s in California with the Opioid Epidemic. It could be worse as the numbers show. We have a way to go to get this epidemic under control but at least we are not starting from the bottom!

    https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html

    Deaths attributed to Cannabis= 0 ….. Zero…… So…what Wars should we be fighting?

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