The statistics are sobering. Last year, nearly 900 Marylanders died from opioid misuse, including 578 from heroin alone, which means that opioid deaths account for more than 85 percent of all intoxication deaths throughout the state. And the problem is worsening; the 2014 data represent a 22 percent increase from the previous year and a 76 percent increase since 2010.
Opioids are painkillers, like morphine and others, and the stories of the pain they cause are saddening. Heroin and opioid misuse touches every county, city, town and subdivision in Maryland. It knows no racial, economic, age or gender boundaries.
It even attacks babies still in the womb. A powerful piece in The Washington Post this summer chronicled the trials of Makenzee Kennedy, an infant who spent the first months of her life in Maryland's Mount Washington Pediatric Hospital, where she battled to overcome a heroin addiction that had been passed on in utero. Data suggest that the incidence of cases like Makenzee's — "neonatal abstinence syndrome" — have quadrupled over the past decade.
It's time to take a stand.
Stemming the tide of opioid misuse demands action from all who touch the lives of those affected by this disease — law enforcement professionals, legislators, health care providers, long-term addiction rehabilitation specialists, behavioral health experts and friends and families.
Maryland's hospitals and physicians are on the front lines of this battle and have already begun work to reduce the chances of heroin addiction. According to the Centers for Disease Control and Prevention, 45 percent of people who use heroin are also addicted to prescription opioids.
That's why the Maryland Hospital Association, working with the Maryland Chapter of the American College of Emergency Physicians, has developed opioid prescribing guidelines to be used in emergency departments in Maryland. The guidelines, embraced by Maryland's acute care hospitals and their emergency department physicians, were crafted to allow doctors the flexibility to prescribe opioids when medically necessary while encouraging practices that can reduce the risk of opioid addiction. The guidelines promote:
•Screening and patient education to help detect and treat conditions that can lead to misuse and safeguard patients against the development of those conditions;
•Using existing tools like the state's electronic health information exchange and prescription drug monitoring program to allow health care providers to more effectively track potential misuse of opioids, and
•Standardizing prescribing practices to reduce unnecessary prescriptions (and the number of pills prescribed) to diminish misuse of opioids.
These and other efforts to standardize and improve opioid prescribing in emergency departments are just pieces of a complex social and medical puzzle, and hospitals and physicians welcome the opportunity to work with other stakeholders to address this dangerous and immediate threat. In six months, the Maryland Hospital Association and the Maryland Chapter of the American College of Emergency Physicians will convene emergency medicine leaders to take a hard look at the guidelines' effectiveness.
Gov. Larry Hogan's administration, as well as several key legislative leaders, deserve great credit for shining a spotlight on this problem and for their commitment to developing means to tackle it. Earlier this year, Governor Hogan and Lt. Gov. Boyd Rutherford created the statewide Heroin and Opioid Emergency Task Force. The task force has now identified a series of recommendations, including the prescribing guidelines now being used in hospital emergency departments, which collectively take aim at Maryland's opioid epidemic and form a framework for further consideration and action by the administration and General Assembly.
While it will take time, dedication and vigilance to chip away at this pervasive problem, hospitals and physicians are attacking the challenge on the front lines of care.
Carmela Coyle is president and CEO of the Maryland Hospital Association. Her email is firstname.lastname@example.org. Dr. William Jaquis is president of the Maryland chapter of the American College of Emergency Physicians. His email is email@example.com.