The Impact of The Opioid Crisis In Rural America

Rural Opioid Use and Impact

Rural adults tend to think that opioid misuse is more of an urban problem than a rural problem. American Farm Bureau Federation and National Farmers Union sponsored survey tells a different story; nearly half of rural adults report being affected by the opioid crisis and even admit that it is easy to access opioids. In the rural farming community, these rates significantly increase with 75% reporting being affected and ease of access to opioids.

Pain Management

Rural Americans’ jobs tend to be more physically intensive – think agriculture and coal mining. Strenuous physical labor over 15 to 20 years contributes to medical conditions associated with acute and chronic pain. In the 1990s, prescription opioids were marketed to physicians as a safe, non-addictive way to treat pain. Additionally, there was a new medical campaign pushing providers to address and alleviate their patients’ pain.

Since then, the addictive nature of prescription opioids has come to light, and their ability to effectively treat chronic pain long-term is unproven. News headlines in 2016, highlighted the flood of manufacturer opioid shipments to small, rural counties despite rising overdose rates. As prolific “doctor shopping” and cash-based pain clinics operated in rural counties and mom-and-pop pharmacies were filling legal controlled substance prescriptions, prescription opioid addiction and diversion gained a foothold in rural America. Rural providers still face a tough decision when treating pain in their patients as access to physical therapy, an alternative to pain meds, is typically not easily accessible for their patients.

Prenatal Care

While limited studies have been done, JAMA Pediatrics did find from 2004 to 2013, infants born with drug-dependencies increased sevenfold in rural areas. Urban areas increased as well, but at nearly half the rural rate. With opioid misuse on the rise, the lack of prenatal opioid treatment and physician experience in rural areas is alarming. Mother and child’s health are at risk and a generational cycle is put in motion.

Some providers are taking it upon themselves to help combat this epidemic. One notable physician in California’s Shasta County helps train and mentor other primary care physicians in the area of opioid addiction and pregnancy. Patients in her county have no other local treatment or care options.

Addiction Treatment

In rural America, the ratio of people per licensed drug and alcohol counselor is more than three times less than urban areas. In addition to the lack of addiction treatment options, treatment options can be cost prohibitive and accessibility can be near impossible with a lack of public transportation. Additionally, the stigma surrounding opioid addiction plays a role in rural patients not seeking treatment.

Informed Prescribing Within The Workflow: A Step Towards Combating Medication Misuse

The Role of Technology In Combatting The Opioid Crisis

On a positive note, telehealth is well-positioned to be a tool to help those in rural areas needing addiction treatment. Federally, HHSA and SAMHSA provide funding to rural health organizations and community health centers to aid in substance abuse disorder treatment and recovery.

Reducing medications prematurely or making access difficult for patients with a medical need can lead to serious physical and mental health issues. Likewise, overmedicating and overprescribing can cause deadly harm and contribute to drug diversion. With proper use of technology, we hope to ensure that medications land in the correct patient’s hands while under physician care.

Combating the opioid crisis is a joint effort on the state and federal levels from lawmakers and law enforcement to care givers and prescribers. Identifying those that are addicted or at risk is crucial to improving patient care before an overdose has a chance to occur. EPCS and PDMP aim to arm physicians with information, so patients are less likely to overmedicate, share or sell medications, or become at-risk of addiction.

While eRx has been federally mandated, there are two relatively newer tools – EPCS and PDMP – that have the ability to impact and combat the opioid crisis. Already, 40% of states either have required EPCS use, have impending deadlines, or have proposed legislation. With nearly 95% of US pharmacies EPCS enabled, today, providers can effectively send all prescriptions within a single, secure electronic workflow.

Utilization of Technology In Modern Rural Healthcare

What Is EPCS  (Electronic Prescriptions for Controlled Substances)?

EPCS stands for Electronic Prescriptions for Controlled Substances and is the secure, electronic transmission of a controlled substance prescription direct to a pharmacy, and PDMP (Prescription Drug Monitoring Program), which are state programs that collect prescription data with the intention of allowing prescribers to review a patient’s medication history prior to prescribing and contributes to combatting the rural opioid crisis.

If your clinic is not already leveraging this technology, contact Azalea Health for an EHR demo including EPCS to see how an EHR built for rural practices can benefit you and your patients.

How Does EPCS Work?

Like eRx, EPCS is integrated within your EHR’s prescribing workflow. EPCS requires two-factor authentication from prescribers – typically a password and dynamic code from a key fob.

Benefits of EPCS

  • Reduces fraud and abuse
  • Protects prescriber’s DEA #
  • Increases patient satisfaction
  • Increases patient safety

EPCS Statistics

  • 30% of prescribers are EPCS-enabled
  • 95% of pharmacies are EPCS ready
  • 4 states require EPCS (MA, MN, NY, CT)
  • 7 states have an impending EPCS deadline
  • 10 states with proposed EPCS legislation

ECPS Resources

What Is PDMP (Prescription Drug Monitoring Program)?

PDMP stands for Prescription Drug Monitoring Program and are state programs that collect prescription data with the intention of allowing prescribers to review a patient’s medication history prior to prescribing.

How Does PDMP Work?

PDMP access varies by state. In some states, prescribers log onto a website to check prescription history, but the majority of states are able to integrate within EHR’s EPCS workflows.

PDMP Benefits

  • Identify patients at risk of abuse
  • Identify patients suffering from addiction
  • Provide better medical care
  • Reduce drug diversion and abuse
  • Interstate data sharing policies vary by state
  • A small subset of states requires veterinarians to report

PDMP Statistics

  • 49 states have operational PDMPs (MO does not)
  • 42 states require prescribers to access the PDMP prior to prescribing
  • 34 states allow PDMP data to be integrated within EHRs
  • In states with required use, 90% of prescribers adhere
  • 47 states are adding the ability to view nearby state medication data

PDMP Resources

Sources:

  1. https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/
  2. https://www.fb.org/issues/other/rural-opioid-epidemic/
  3. http://thehealthcareblog.com/blog/2018/09/25/remember-that-oath-epcs-and-the-fight-against-opioid-abuse/
  4. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
  5. https://www.chcf.org/blog/rural-pregnant-women-with-opioid-addiction-find-a-doctor-not-a-judge/
  6. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2592302
  7. https://www.washingtonpost.com/national/health-science/states-require-doctors-to-use-prescription-drug-monitoring-systems-for-patients/2018/01/12/c76807b8-f009-11e7-97bf-bba379b809ab_story.html
  8. https://www.addictioncenter.com/community/substance-abuse-mental-illness-and-access-to-care-in-rural-america/
  9. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-poured-m-painkillers-into-wv-amid-rise-of/article_99026dad-8ed5-5075-90fa-adb906a36214.html
  10. https://www.maratp.org/rural-vs-urban.html
  11. https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia

 

 

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