The State of NC’s Opioid Crisis – A Physician’s Perspective
An In-Depth Interview with Dr. Timothy Lietz, MD, FACEP
President & CEO, Mid-Atlantic Emergency Medical Associates (MEMA)
Past President, NC Medical Board

 

Dr. Timothy (Tim) Lietz recently participated in a panel discussion related to compliance with opioid prescribing practices as part of the Charlotte Regional Healthcare Compliance Conference. We had the opportunity to sit down with Dr. Lietz to discuss the panel and the larger issue of our state’s opioid crisis.

 

Tell me a little more about the conference – what was the purpose of the panel and why were you selected as a panelist?

This panel was hosted by the Health Care Compliance Association (HCCA) and was designed to address how prescribers and healthcare organizations alike are helping manage NC’s opioid epidemic through the careful monitoring of and compliance with recent changes to prescribing guidelines as set forth by the NC STOP Act.

As an emergency department physician, we care for so many patients with acute pain, so we’re obviously a key group that must be engaged in implementing solutions. For over a decade, the physicians and staff of Mid-Atlantic Emergency Medical Associates (MEMA) – the physicians,  who provide emergency care at Novant’s Charlotte region emergency departments – have partnered with Novant Health to help address the growing opioid epidemic.

As such, the panel also included Bridget Bridgman, senior director of medication safety and outcomes for Novant Health. MEMA Partners with Bridget’s team and hospital administration to ensure patients in the ED and throughout Novant are treated appropriately with opioids.

In addition, I am the Immediate Past President of the North Carolina Medical Board – an organization that has been incredibly engaged in educating its licensees (which include physicians and advanced practice providers) on the opioid crisis, new prescribing guidelines and the consequences of improper prescribing practices.

 

What changes have been put into place to address the opioid epidemic in North Carolina?

There has been so much work put into addressing this issue – health systems, private physician groups, the NC Medical Board and countless others have spent years identifying and implementing solutions. The STOP (Strengthen Opioid Misuse Prevention) Act of 2017 was put into place here in North Carolina, which began limiting the number of opioids that can legally be prescribed for acute pain or after surgery.  This really helps to ensure patients aren’t getting more medication than is needed, which could either lead to abuse or, if leftover unused, could get into the hands of someone other than who it was prescribed for. This legislation also ensures better reporting of opioid usage with the NC Controlled Substances Reporting System.

Additional programs have also been put into place by the North Carolina Medical Board to identify those physicians who prescribe the most opioids across the state. Known as the Safe Opioid Prescribing Initiative (SOPI), the goal of this program is to target the top 2% of prescribers across the state in order to either better educate them on best prescribing practices or to enforce disciplinary action for those who may not be following guidelines. These efforts continue with other initiatives that are looking carefully at statewide prescribing data and other key indicators that may help identify prescribers who may need coaching or disciplinary action.

 

How did we get here – what factors led to such a widespread, national epidemic such as this?

Looking back, it really was a confluence of factors that got us to where we are today.  First, new medications were developed and marketed heavily to prescribers as non-addictive treatments for pain. At the same time, patient satisfaction became a top priority for hospital systems who identified pain management as a huge area of opportunity. Government payors such as Medicare and Medicaid threatened to reduce payment to hospitals who received sub-par patient satisfaction scores – thereby resulting in pressure to ensure patients’ pain was well-managed. As you can imagine, patients who feel like their pain was not well managed while in the hospital do not typically give high patient satisfaction scores when they are surveyed. It really was the perfect storm.

 

What are physicians such as yourself doing to help address the issue?

Physicians and advanced practice providers (APPs) including physician assistants, nurse practitioners are working hard with health systems, the NC Medical Board and other organizations such as the NC Consortium for Opioid Abuse to be a part of the solution. As prescribers, we understand a great deal of the problems can be addressed by modifying our prescribing habits and educating our patients, and we’ve made great strides in doing so. Long before the NC STOP Act, MEMA developed prescribing guidelines for all of our emergency departments because we knew something needed to be done to limit the use and availability of opioids. We were ahead of the curve then and we continue to work with our partners at Novant to ensure we’re doing everything we can to be a significant part of the solution.

 

Are these efforts moving the needle?

It’s really hard to know if we’re making progress – since it’s really only been a year since the STOP Act was put into place. Certainly, it has helped reduce the number of opioids prescribed.. We haven’t addressed the many other needs that come with battling an epidemic of this proportion.  As caregivers, we have limited access to resources to help those patients with substance use disorder – therefore, we’ve seen a significant rise in the use of illicit drugs and the health and societal problems that come with that. Of equal importance is that we are still looking for viable alternatives to help our patients manage their pain. We can recommend yoga, exercise, weight loss and physical therapy, but patients either don’t want to or put in the effort, or they lack the time and/or financial resources to do so.  It’s a real challenge and one that is very troubling to physicians.

 

What’s the next phase of addressing this issue?

Our next priority has to be to address some of the challenges we’ve just discussed. We need to increase access to treatment for substance use disorders – and to the medications needed to treat opioid overdose such as Narcan (naloxone). Likewise, our state must come together to address issues such as the increase in heroin supply and trafficking that has increased significantly since we’ve locked down the abuse of prescription opioids. Finally, as prescribers and health care providers, we need to focus on developing new protocols for managing pain. None of this is easy to do, but by working together – I believe we can continue to make great progress. Our patients, the state and this community deserve our continued focus on this important issue.