The issue of painkiller addiction and death in New York's Staten Island borough has captured the attention of the city's health department, which responded with a new television ad campaign and advocacy of a bill to increase access to a drug that can reverse opioid overdoses.
By all measures, the problem is both critical and complex. In New York City, the opioid analgesic overdose death rate increased 267% between 2000 and 2011, followed by a slight decrease in 2012. In 2012, Staten Islanders had the highest rate (10.1 per 100,000) of opioid analgesic overdose deaths - more than three times as high as all other boroughs.
Opioid analgesics include drugs such as oxycodone (e.g., Percocet or OxyContin) and hydrocodone (e.g., Vicodin). Between 2008 and 2012, the number of New York City residents who filled an opioid analgesic prescription increased by 13%, from 632,000 (75 per 1,000 residents) to 740,000 (85 per 1,000 residents). In 2012, Staten Island residents filled prescriptions at a higher rate (122 per 1,000 residents) - 1.5 times more than residents of all other boroughs (86 per 1,000 residents). In 2012, a total of 190 New Yorkers died from opioid analgesic-related overdoses - about one death every other day.
The pundits have yet to find a reason for this epidemic. Whether fingers point at the stress of a poor economy during the recession, a higher-than-average number of vocational workers who become injured on the job and subsequently addicted to their painkillers or just lax law enforcement, change appears to be in the works.
Karyn Treval, MSN, RN, CEN, nurse manager of the emergency department at Staten Island University Hospital, can attest to positive change in 2014.
"In the ED, we've placed clearly delineated signage stating our position on the prescription of opioids upon discharge," she said. "I can honestly say there's been a decrease in the number of patients who are seeking drugs."
There are general characteristics that cue Treval and her fellow nurses into the idea a patient may be searching for a prescription.
"Think about your own mental state when you come into the ED," she said. "If you're telling the nurses not to use morphine and telling them what works for you, that's a clue."
In Staten Island, a high percentage of the people abusing drugs are teens. If she has suspicions, Treval talks to families to learn if the patient has experienced changes in sleep patterns, weight gain or loss, agitation, restlessness or recent poor performance in school and work.
The New York Department of Health is also targeting the teenage and young adult population with a television ad featuring a Staten Island parent whose 22-year-old son died of an opioid analgesic overdose.
"If misused, opioid painkillers can be just as dangerous as heroin and other illicit drugs and can lead to addiction or fatal overdose," said Health Commissioner Thomas Farley, MD, at last year's unveiling of the advertising campaign. "These ads show that the national prescription painkiller problem hits close to home."
To specifically address opioid analgesic misuse and abuse on Staten Island, Commissioner Farley led two conferences in June for doctors in the borough.
From June to August 2013, the health department visited more than 1,000 healthcare providers across Staten Island to educate them about the department's opioid prescribing guidelines and increase awareness about opioid analgesic misuse and its health consequences. With Staten Island University Hospital, the health department co-sponsored training for physicians on the use of the effective medication buprenorphine, for treating opioid addiction. The Health Department also supplies naloxone, a medication that can reverse opioid overdoses, to overdose-prevention programs. Additionally, the New York City guidelines for prescribing opioids from EDs have been adopted by 35 EDs across the city, including Staten Island University Hospital.
"Our physicians don't set out to cause addiction," noted Treval. "They have the intent to do no harm and take care of patients in the proper manner. Their inherent goal is doing the right thing."
Treval said Staten Island University Hospital doctors and nurses are active within local chapters of their professional organizations, such as the Emergency Nurses Association.
"This epidemic is really in the forefront of the professional emergency associations in the past couple years," she noted. "It's going to require a culture change."
Increasing Access to Naloxene
In the meantime, the New York City Health Department publically urged state lawmakers to approve legislation that would increase access to naloxone, a drug that can reverse prescription opioid and heroin overdoses.
The bill would allow trained laypeople to dispense naloxone under a prescriber's authorization. If passed, a trained layperson could dispense naloxone to someone at risk of an overdose or give the naloxone to a friend or family member of that person.
Opioid overdoses most commonly involve slowed or stopped breathing. Naloxone, if administered promptly after an overdose, reverses the overdose and restores breathing in a few seconds.
Despite its benefits, naloxone is currently only accessible through New York State certified Opioid Overdose Prevention Programs. There are just 52 of these programs in New York City.
Naloxone has no known adverse side effects or potential for abuse and it has been widely used by emergency medical professionals in ambulances and emergency rooms for decades. States across the country have passed similar bills to expand access to naloxone, including California, Illinois, Kentucky, North Carolina and Vermont.
Since the establishment of the New York State Opioid Overdose Prevention Program in 2006, more than 650 overdose reversals have been reported statewide.
In the long-term though, the responsibility to reverse addiction lies solely with the patient.
"It's very difficult for an addicted patient to look within themselves and acknowledge a problem," said Treval. "We can suggest community counseling programs, as can their families. As clinicians, we can offer support and guidance but we can't bring them into counseling."
Robin Hocevar is on staff at ADVANCE. Contact email@example.com.