University of Michigan Injury CenterOpioid Overdose Summit

December 1, 2015

Jeffrey S. Desmond MDInterim Chief Medical Officer

University of Michigan Health System

A national problem with national attention

We recognize that opioid medications may lead some people to addiction. That’s why I am calling on physicians to carefully assess addiction risk before prescribing, then to prescribe the smallest possible dose of pain medications for the shortest time possible

I’m also encouraging patients everywhere to have open, candid converstations with their doctor about opioids…. It’s also OK to ask whether alternatives to opioids would be effective for you.

Incidence of Substance Abuse by Profession

• Pharmacists 15% -19%• Nurses 10%• Physicians 8% -18%

The Food and Drug Administration estimates 100,000 people working in hospitals struggle with addiction

Addicts often presume that controlled substances are safer than street drugs

The Issue at UMHS

A nurse's death, a doctor's overdose and 16,000 missing pills from the outpatient Pharmacy – October 26, 2014

By John Counts | johncounts@mlive.com The Ann Arbor News

Safety and Accountability Problem

• Inconsistent compliance with regulatory requirements

• Processes favored convenience over control• Lax practices and documentation around

management of controlled substances• Controlled substance surveillance difficult • Poor accountability • Inconsistent and delayed consequences• Culture = reluctant to speak up

Comprehensive Program

• Procurement• Security and storage• Prescribing• Preparation and distribution• Administration• Waste practices and management• Suspicious Activity Monitoring

(discrepancies) and Incident Response

• Education / communication

• Strict controls

• Rigorous documentation

• Clear accountability

• Meaningful consequences

Institutional Oversight

UMHS-CS Improvement Initiatives • Controlled substances oversight committee• Medication storage security• Drug free workplace policy

– Pre-employment screening– For-Cause Testing (future - random drug testing)

• Anesthesia work flow process changes• Improvement auditing of wasting practices• Increased scrutiny for discrepancies at Omnicell• Suspicious activity monitoring • Omnicell bio-ID login• Pharmacy based Diversion Prevention Program

Ongoing Work• Accountability

• Systematic documentation => performance evaluation => meaningful consequences

– Ongoing reviews / audits• policies/standards/processes/record keeping

• Education / Communication• Consistent response to possible diversion

• Bargained for workforce complexities

• Suspicious Activity Monitoring• Anesthesia kit control • Controlled Substance storage

Drug Diversion is a Multi-Victim Crime

Employee Risks:• Health - morbidity and death• Progression to illicit substances• Risky behaviors• Incarceration• Loss of employment• Revocation of license

Patient Risks:• Lack of pain control• Infection risk• Care by an impaired employee

Health System Risks:• Patient harm -- CDC estimates ~30,000 people

exposed to Hep C in last decade by infected hospital workers using narcotics intended for patients.

• Civil and regulatory liability• Reputation and brand at risk*

Get the Word Out

Drug Diversion on Vimeo

Speak Up - Save a Life

SUMMIT OBJECTIVES

• Bring attention and focus to a critical and growing health issue.

• Present the state of the prescription drug opioid (PDO) research literature and highlight directions for future PDO research and prevention by identifying gaps and priorities.

• Facilitate new collaborations among PDO researchers and to bridge research and public health practice.