Guest Commentary: Communities in Crisis - Harmful Effects of Prescription Drug Abuse

Michael Toscani, PharmD
Project Director
Jefferson School of Population Health

The prescription drug abuse problem in the United States has reached enormous proportions, notably in our teenage population. Unintentional drug overdose death rates have risen steadily since 1970 and have increased roughly five-fold since 1990. According to National Vital Statistics, the death rate in 1970 was 1.23 per 100,000, and by 2007 it had risen to 9.18 per 100,000. A 2008 survey found that 61% of teens feel that prescription drugs are easier to obtain than illegal drugs.

Many teens (40%) believe that prescription drugs, even if they are not prescribed by a physician, are much safer to use than illegal drugs, and almost a third believe that it is okay to use prescription drugs without a physician’s prescription. A recent report from the NIH indicated that the trial use of opioids by individuals by 12th grade has risen to 4.7% for Oxycontin (oxycodone) and 9.7% for Vicodin (hydrocodone). Most teens (58%) say they obtain their prescription meds from their family’s medicine cabinet, and 42% say that these medications are widely available.

I’ve had the opportunity to participate in many educational sessions on this topic over the past several years observing views from law enforcement, pain management and addiction specialists, and students in a designated recovery high school and their principal. Some of the key take away messages from these programs include:

1. Lock your meds in a limited access area and keep an inventory of the products.
2. You can dispose of unused medications by flushing them down the toilet.
3. Never let anyone use a medication that has not been prescribed for them.
4. Addiction is a neurobiologic disease. Once high risk individuals come in contact with an addictive substance, they are driven to seek that “high” at all costs to them and their families. There are several assessment tools that can be used to predict risk of drug abuse, such as the ORT (Opioid Risk Tool).
5. Most students begin their habit with gateway products such as marijuana and/or alcohol, progressing to Rx products and, at times, to more potent or potentially dangerous illicit substances.
6. Parents should have discussions with their children about these risks and if a problem surfaces, seek immediate treatment from professional sources.
7. Addiction is a chronic relapsing disease, but there is hope for recovery from treatment centers, recovery high schools and programs, and support groups.
8. Health professionals and law enforcement can play critical roles in reducing misuse and abuse of prescription medications and serve as key educational resources for the community.

Stay informed on this public health issue !!!

A National Quality Strategy---FINALLY

For persons like me, the recent debut of the National Strategy for Quality Improvement in Health Care, and the subsequent release of the Partnership for Patients, is an amazing confluence of events with roots deep in the quality and safety movement. The National Strategy, released in late March 2011 calls for sweeping changes in the current system that would promote three core goals--Better Care, Healthy Communities and Affordable Care. It would implement upwards of 65 new quality measures and hold providers accountable for these measures with a host of financial incentives and disincentives.

The National Strategy has deep roots in the IOM Reports "To Err is Human" and "Crossing the Quality Chasm". With Dr Berwick at the helm of CMS, himself a co author of both aforementioned IOM reports, it is no wonder that the national strategy reflects many of Berwicks long held ( and laudable) views. To me, it is as if the Triple Aim, of IHI fame, is now, to some extent, national policy. I am excited about seeing the Triple Aim literally coming to life as the law of the land!!!

The Partnership for Patients, which debuted on April 12th, is a follow up political rallying cry to energize the movement even further. It calls for a pledge of support for the goals in the Strategy. It also serves as the vehicle for a new round of financial support for this work, to the tune of about $1billion. Already, major national provider groups are gearing up to attempt to garner some of this support.

Naysayers might balk at all of this but not me. I see a bright future ahead when national policies are finally focusing on some of the work that our school, and many other organizations, have been focused on for years. I think we will see many more providers express interest in the quality and safety movement and as a result, lives will be saved and costs will be moderated. I am excited to be leading our School of Population at such a watershed time in our history. DAVID NASH

Guest Commentary: Celebrating National Public Health Week

Jeffrey Brenner, MD


By Rob Simmons, DrPH, MPH, MCHES, CPH
Program Director, Master of Public Health (MPH) Program
Jefferson School of Population Health

This past week Thomas Jefferson University’s School of Population Health, in cooperation with the Jefferson Medical College, Department of Family & Community Medicine, and the Jefferson Center for Inter Professional Education (JCIPE) celebrated National Public Health Week with a lunchtime symposium entitled, “Reinventing Health in One of America’s Poorest Communities: Camden, New Jersey.”

The program featured the Camden Coalition of Healthcare Providers, a non-profit organization committed to improving the quality, capacity, and accessibility of health care to vulnerable populations in an effort to improve their health status and reduce healthcare costs. Serving one of America’s poorest communities, the Coalition's work is dependent on creating complex collaborations amongst three highly competitive hospitals, two local Federally Qualified Health Centers (FQHC), and small private physician practices in Camden. Through the Coalition, local stakeholders are working together to build an integrated health delivery model to provide better care for Camden City residents. The group receives funding from local and national organizations, including the Robert Wood Johnson Foundation. Their efforts have received national recognition through a feature article on January 24, 2011 in the New Yorker by Dr. Atul Gawande.

The presenting team included Jeffrey Brenner, MD, Executive and Medical Director, Kathy Jackson, MSN, Nurse Practitioner, Ana Aningalan, MSW, Social Worker, Kelly Craig, MSW, Social Worker and Director of Care Management Initiatives and Jessica Cordero, Community Health Worker. After an overview by Dr. Brenner of the Camden community and the healthcare issues and barriers facing Camden residents, the team discussed a couple of complex case studies and addressed questions from the audience of 175 population health and health care professionals and students.

Overall response to the symposium was excellent. Participants look forward to additional professional development opportunities provided by Jefferson and next year’s National Public Health Week symposium.

Guest Commentary: Actuarial Efforts in Cost Control

Rob Lieberthal, PhD
Faculty, Jefferson School of Population Health

Readers of this blog are familiar with my efforts to get members of the Society of Actuaries more engaged in population health. I have also been getting more involved with the Casualty Actuarial Society, which focuses on property and casualty insurance. The casualty actuaries participate in several lines of business that involve healthcare: workers’ compensation insurance, medical malpractice, and auto insurance.

I am used to thinking of medical costs as being in our control as long as we are willing to make hard choices. Researchers have identified countless examples of high and low value medical care. I also know that there is a strong emotional component to medical care. Large employers just don’t want to say no to low value (cost-ineffective) care that their employees want and that other employers are willing to pay for. In my mind, cost control can occur as long as we can change peoples’ attitudes about medical care—a tall order to be sure!

The casualty actuaries I have worked with create models with the assumption that medical spending growth is out of their control—they take the level and growth of spending for any condition as a given. Medical spending growth is a result of outside factors. For example, as standards of care change, a workers’ compensation insurer may have to provide benefits that meet the current standard of medical care, even if it is much more expensive than care that was available at the time the policy was written, an effect called “social inflation.” Casualty actuaries often work on lines of insurance where insurers will be paying claims in 2014 for a contract written in 2011. The long tail of claims means that casualty actuaries have always worried about uncertainty regarding future spending even if they couldn’t affect it.

Casualty actuaries are now realizing that they have a part to play in bending the cost curve. The Casualty Actuarial Society is engaging in research to figure out how to deal with the cost curve problem through a new Health Economics Working Party. The current goal is to educate their members, but the long-term goal is to “…address behavioral issues of casualty carriers in response to U.S. health care reform.”

The working group is still in its early stages, and I am excited about this new actuarial endeavor. Widespread experimentation in different approaches is the best way to find the solution to our vexing cost curve problem. Local efforts, such as the Camden Coalition of Healthcare Providers and the Special Care Center of Atlantic City, NJ, are examples of different people trying to lead by trying something new. Casualty actuaries have a unique expertise and they manage insured populations that may not have had access to innovative models of care in the past. The decision by casualty actuaries to become more actively involved in health reform is a change for the better.