As the opioid epidemic continues to take its toll on Americans, the Centers for Disease Control and Prevention is bolstering public health data reporting and collection to improve the timeliness of information sharing to help enable a real-time response to the crisis.
Even so, Debra Houry, MD, director of the CDC’s National Center for Injury Prevention and Control, told the Senate Health, Education, Labor and Pensions Committee on Thursday that the opioid overdose epidemic is one of the few public health problems that is getting worse instead of better.
“Drug overdoses have dramatically increased—nearly tripling over the last two decades,” testified Houry, an emergency physician, who added that the opioid overdose crisis has led to a “drop in life expectancy for the first time since the AIDS epidemic in 1993.”
In response, CDC is working closely with state health departments and now funds 45 states and Washington, D.C., to advance prevention at the community level, including improving prescription drug monitoring programs (PDMPs), according to Houry.
For instance, in Kentucky, Houry said prompts were added to that state’s PDMP to alert physicians to high doses of prescribed drugs, which resulted in a 25 percent reduction in opioid prescribing to youth. Kentucky was the first state to require doctors to check patients’ prescription drug history. “These investments can literally save lives,” she added.
However, an interim report released in August by the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended that the federal government provide funding and technical support to states to improve interstate data sharing between state-run PDMPs to better track prescriptions written for addictive medications.
During Thursday’s Senate committee hearing, Sen. Sheldon Whitehouse (D-R.I.) expressed his concerns that the lack of state-to-state integration between PDMPs continues to be a challenge and that without data sharing between states people will be able to see providers across state lines to procure prescription medications illicitly.
“I hope that you will support PDMP grants that do a better job” of preventing individuals from crossing state lines for the purpose of doctor shopping, said Whitehouse. “It is ridiculous for somebody to be able to go across the Rhode Island-Massachusetts border and have it not picked up” in the electronic databases.
Likewise, the American Hospital Association sent a statement to the Senate committee recommending the strengthening of PDMPs, ensuring that their information is shared across state lines, as well as including PDMP information in certified electronic health records.
“The AHA believes that fully employing and connecting prescription drug monitoring programs—statewide electronic databases that collect designated data on substances dispensed in the state—will bolster federal efforts to combat the opioid epidemic,” read the statement. “We understand that most PDMPs already engage in some level of information sharing, especially with their neighboring states. In addition to enhancing these efforts, the potential exists to use certified electronic health records to improve knowledge about a patient’s active and prior medications. We urge the committee to find ways to support the inclusion of PDMP information in the certified EHR in a timely and efficient manner that is easy for clinicians to use in the course of their clinical workflow.”
Overall, Houry told lawmakers that CDC is strengthening public health data and reporting to better understand the opioid epidemic.
“We are now releasing preliminary overdose data and have improved reporting significantly from a lag of two years down to seven months,” she said in her testimony, adding that CDC is currently releasing quarterly and monthly provisional counts of overall drug and opioid overdose deaths. “And, as part of CDC’s funding to states, we’re ramping up our efforts to get more reliable and timely data from emergency rooms, medical examiners, and coroners.”
Under the Enhanced State Opioid Overdose Surveillance (ESOOS) program, funds are being used by medical examiners and coroners to conduct comprehensive toxicology testing and to bolster data sharing with the CDC. Houry noted that the ESOOS program, which was established last year, for the first time now tracks non-fatal opioid overdoses in addition to fatal opioid overdoses.
She also pointed out that what is particularly unique and innovative about the program is the use of emergency department and emergency medical services data to track and analyze morbidity data, which is being leveraged for an early warning system to detect sharp increases or decreases in non-fatal overdoses.
“We have a better understanding of the changing epidemic so that states can respond accordingly,” Houry testified. “This is the value of informed and nimble public health.”
Nonetheless, while CDC has made progress, she acknowledged that improvements are still needed to develop the infrastructure—such as toxicological testing and electronic reporting—to create a stronger detection system that identifies potential problems sooner.
To help health departments around the country, CDC is now posting on its website opioid prescribing rates at the county level.
“Anyone can go in and see where the highest prescribing counties are—that way state health departments can intervene,” concluded Houry. “We are starting to go in the right direction. The amount of opioids prescribed has gone down about 10 to 15 percent. If you look at where we are—though—compared to 1999, we’re still three times what we were. The slope is going down but there’s still tremendous progress that needs to be made.”
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