Health Index Priority: Decrease Prescription Drug Misuse and Dependence
MaineHealth is implementing a chronic disease management program that incorporates appropriate prescribing of opioids and education about prevention of and treatment for opioid use disorder as close to home as possible.
Why does MaineHealth focus on decreasing prescription drug misuse and dependence?
- Prescription drug and opioid overdose has risen sharply over the last decade and is considered one of our most pressing public health issues.
- Between 2014-2016 and 2015-2017, the age adjusted rate of drug overdose deaths increased by 32% compared to 19% nationwide.
- Maine's recent surge in overdose deaths continued in 2017 with 443 lives lost, compared to 378 in 2016.
- In Maine, about 8% of babies born in 2018 had some degree of Neonatal Abstinence Syndrome.
- Drug overdose is now responsible for the most years of life lost prematurely among men under age 70 in Maine.
We support a variety of clinical, community and policy actions to help decrease prescription drug misuse and dependence throughout the MaineHealth service area. Here are some of the ways MaineHealth and our partners are responding:
The Health Index initiative tracks and monitors a variety of data source to measure progress being made to decrease prescription drug misuse and dependence. In 2016, MaineHealth leaders set bold, aggressive targets for two of these measures as a way to challenge MaineHealth organizations to continue achieving positive steps toward the MaineHealth vision.
Short-term measure and target:
- 100% of opioid prescribers at MaineHealth organizations completed three hours of Continuing Medical Education on prescribing opioid medication by December 31, 2017.*
* Since this target was developed, a 2016 Maine state law now mandates that opioid prescribers complete 3 hours of CME on opioid prescribing every 2 years. MaineHealth is now focused on continuing to reduce the number of patients prescribed opioids above the 100 MME (morphine milligram equivalents)- this threshold is considered to be high risk for addiction and overdose.
Long-term measure and target:
- For the period 2018-2020, the 3-year, age-adjusted rate of all drug overdose deaths in the MaineHealth service area will 12/100,000 or less.
In 2018, providers at MaineHealth practices (graphic above) continued to reduce the number of patients who were prescribed opioids with an estimated daily morphine equivalent of ≥100 mg equivalents. This level of morphine equivalent increases the risk of developing opioid use disorder and the risk of overdose. Overall the number of patients with high-risk levels of morphine equivalents has been cut significantly (graphic below) between 2015 and 2018.
Comparing the three-year drug overdose death rate from 2014-2016 to 2015-2017, Maine had the fourth largest increase in the nation. The state with the highest age adjusted rate in the U.S. is West Virginia with 52.3 deaths/100,000 in 2015-2017 followed by Ohio (39.7) and New Hampshire (37.7), Maine had the 11th highest rate in the U.S. during this period.
The increase of overdose deaths in Maine and the nation is a result of a shift from increasingly scarce prescription opioids to more available and less expensive heroin. With this shift has come a higher risk of overdose from heroin and the even more deadly fentanyl that is often mixed with, or substituted for, heroin.
In Maine,about 8% of all births in 2018 had Neonatal Abstinence Syndrome (NAS).
NAS occurs in newborns when a mother who is addicted to or treated with opioids during pregnancy and refers to post-natal opioid withdrawal syndrome. Babies exposed can have lower birthweight, more preterm births, difficulty sleeping and eating and are more anxious. There is limited data on the long-term developmental outcomes related to opioid exposure during pregnancy.
Counties with the highest rate of NAS births include Washington and Oxford counties. Those with the lowest rates of NAS births are in Cumberland, York and Franklin counties.
Although many may associate the involvement of heroin and other street drugs with overdoses among younger adults, there actually has been an increase in the proportion of older adults dying of overdose. In the MaineHealth service area, the percentage of individuals who were ages 45 and over, among all who died of a drug overdose was 41% in 2015-2017, up from 30% in 2000-2002.