Last year Massachusetts Gov. Charlie Baker floated a tough new law he hoped would curb the state’s growing opioid epidemic, a societal crisis the state shares with the rest of the country.
The idea: Emergency rooms can hold patients against their will if doctors determine someone is in the grips of a psychiatric crisis that has impaired his or her judgment. So why not apply this same psychiatric hold to drug overdose cases?
This “overdose hold” is an innovative public policy proposal, delivered by a Republican governor known for his pragmatism and willingness to work with Democrats. It came quickly to mind as I read the flood of news in the wake of Prince’s untimely death.
Authorities have found that Prince had prescription painkillers on his person and in his home when he died last week, a law enforcement official told CNN. Investigators also told CNN that when Prince’s plane made an unscheduled landing the week before he died, the pop star’s unresponsive state was likely induced by painkillers.
Quoting sources familiar with the investigation into Prince’s death, the Minneapolis Star Tribune reported that emergency providers at the airport administered Narcan, a drug that quickly reverses the potentially deadly side effects of an opioid overdose; opioids such as oxycodone and hydrocodone are some of the most powerful prescription painkillers. Though EMS took Prince to a local hospital, he “left within a few hours” on his jet, home to Minneapolis.
NBC News reported that police have enlisted the U.S. Drug Enforcement Administration to track down the source of prescription painkillers that they found both on Prince and elsewhere inside his home.
In the days after his death, critics and fans rightly lauded Prince for his “superhuman” breadth of musical talent. But though his artistic works exceeded any reasonable definition of virtuosity, Prince, after all, managed his achievements from the confines of a human body.
Prince’s full medical history and a complete picture of the combination of medications he may have been taking are critical facts the pathologist who’s writing his autopsy report will consider, and all this information remains private at this time. No one can draw conclusions about Prince’s cause of death based on the limited information in the public domain at this time. And I won’t weigh in on it.
Still, there is something important here worth discussing. The headlines raise a whole host of concerns that are familiar to any physician practicing in America today. Let’s direct our attention to some of the possible fixes.
A large National Institutes of Health survey suggests that about 11% of Americans are suffering from chronic pain at any given time. Many millions more people experience more short-term pain that may still land them on opioids, but, it is the 25 million people in chronic pain who are at the highest risk for getting started on this kind of treatment.
Doctors and patients alike want quick fixes, but it takes months to develop chronic pain syndromes and it may take a lifetime to manage them holistically with approaches like physical therapy and the right exercises, mindfulness and cognitive behavior therapy, as well as alternative pain medications with low risk for addiction.
The fact is, though, the American health care system wasn’t designed with these approaches in mind, and that’s something we’re hopefully going to catch up on, thanks to the added attention from the Obama administration and the Centers for Disease Control and Prevention, with their new initiatives to combat opioid addiction.
Again, we don’t yet know what caused Prince’s death. But according to news reports, he remained on the ground in Illinois for just a few hours before getting back on the jet home to Minneapolis. If a painkiller overdose caused that emergency room visit — as investigators believe, a law enforcement official told CNN — could a law like the one Massachusetts Gov. Baker suggested have made a difference?
Doctors need enough time to intervene properly, with something more than a lifesaving opioid reversal drug to stabilize a patient in the moment. It takes a day or more to delve into an entire medical history, to bring in specialists in psychology or psychiatry, to get the consultation with an addiction specialist, and reach out to a patient’s physicians. Baker’s law could keep overdose victims in hospital treatment, even against their will, for up to three days.
After someone overdoses, a patient’s regular doctor may have no knowledge of the event, due to how poorly medical records are connected in this country. There’s no requirement that ER providers make contact with treating physicians, nor often do they have the time or a clear mechanism to do so.
In Massachusetts, concerns over violating civil liberties prevented Baker’s proposal from becoming law. This is unfortunate, as his state is often a leader in cutting-edge public policies that catch on nationwide, such as the Affordable Care Act.
ERs should have the authority and the means to hold on to people who’ve overdosed until they can assemble a plan to prevent the next life-threatening overdose. The policies we put in place must be proportionate to the problem, and the opioid crisis is one of the biggest problems out there.
Moreover, all states but Missouri have prescription drug monitoring databases that keep track of drugs of abuse, so physicians in those states can see what other providers may be prescribing to their patients. But it’s up to each state to set up those databases, and some are better than others. While some states share data with neighboring states, there is no national database.
The Comprehensive Addiction and Recovery Act of 2016, which recently passed the Senate and, it is hoped, will pass in the House, encourages states to share prescription drug monitoring data. While the act lacks teeth, it’s a step in the right direction.
One thing is clear. We’ll have to be tough and creative to fix the systemic failures that are costing American lives, whether famous or not.
