As states across the nation try to stem the growing trend of prescription drug abuse, officials at Cheshire Medical Center/Dartmouth-Hitchcock Keene are putting their own system in place to deal with the problem.
The new system tracks how much pain medication health care providers at the Keene hospital are prescribing, and who they are prescribing to. Last year, a task force studied programs at other hospitals to find out what worked.
At the same time, Cheshire Medical Center/Dartmouth-Hitchcock Keene officials are starting to collaborate with mental health professionals and substance abuse treatment centers in the community to get a handle on the local drug problem.
At the hospital, officials have implemented a risk assessment tool for each patient who comes in with a condition that requires treatment with opioids, according to nurse practitioner Leslie Goldman.
Opioids “can be an important tool ... but we need to make sure it’s done safely,” Goldman said about prescribing pain pills.
Patients who are prescribed opioids such as OxyContin and hydrocodone are required to undergo pain assessments and drug screenings before they receive prescription pain pills, Goldman said.
Staff can monitor patients and try to limit the amount of pain medications they are sent home with, she added. Patients who have substance abuse problems may be designated “high-risk,” and asked to have more frequent follow-up appointments with drug screenings.
Providers also may suggest patients try other methods of pain management, such as acupuncture or physical therapy.
It’s also a way for officials to lessen the incidents of so-called “doctor shopping,” where addicted patients try to get pills from different hospitals or providers in the local area.
Patients who are calling frequently for refills that aren’t due, saying they need more medication to alleviate their pain and going to multiple doctors or pharmacies would raise flags with providers, Goldman said.
“Doctor shopping” is something Cheshire Medical Center/Dartmouth-Hitchcock Keene emergency room doctor John A. Curtis said emergency room providers see, but he also said the fact that the hospital is the only one in Cheshire County makes accountability easier.
The hospital’s response comes from a growing prescription pain pill problem that many health experts say started in doctors’ offices years ago with over-prescribing practices.
Starting in the 1990s, the message to doctors was that no patient should suffer from acute or chronic pain, health officials said. Prescribing trends changed accordingly, with many doctors treating pain “aggressively” with opioids including OxyContin and hydrocodone, Curtis said in a recent interview.
In the following years, the numbers of New Hampshire residents addicted to prescription pain pills spiked, state health officials said.
Health officials also blamed over-prescription of opioids for the state’s heroin problem, which they describe as an epidemic.
The number of people admitted to state-funded treatment programs for prescription opioid abuse rose 500 percent in the past decade, with the sharpest increases occurring in the past two years.
“It became a national and local epidemic,” Goldman said. “We realized we didn’t have as much control of it as we thought we should.”
Since drug screenings at the hospital have become more commonplace, patients have had mixed reactions, Goldman said.
“Some people are really happy to know what they can expect, and some people push back,” she said.
Curtis said he thinks doctors trying to get a hold on prescribing practices is like the “pendulum swinging back the other way.”
“I don’t know what the perfect answer is,” he said.
Officials at Cheshire Medical Center/Dartmouth-Hitchcock Keene recently won an $85,000 federal planning grant from the U.S. Health Resources and Services Administration Office of Rural Health Policy to examine the local drug problem and plan new ways to deal with it.
Medical officials are teaming up with Monadnock Family Services and Phoenix House, a local substance abuse treatment and recovery center, to see where primary care and behavioral care can intersect in the community, according to Phoenix House Director Amelie Gooding.
Dr. Rudy Fedrizzi said he hopes the collaboration among the three organizations will allow health officials to see the full scope of drug abuse in the community and connect some patients to mental health and substance abuse treatment services more easily. Fedrizzi is director of community health clinical integration at Cheshire Medical Center/Dartmouth-Hitchcock Keene.
“I think that each of the three major entities has been thinking about it independently,” Fedrizzi said. “The time is kind of right for all of us to recognize we need one another.”
Gooding said she thinks the hospital and clinic have made “a lot of progress” on curbing over-prescribing.
“They’ve done a lot at their pain management clinic; they’re really trying to address it,” she said.
She said another outcome she hopes from the planning initiative is more of the hospital’s patients being referred to treatment services.
“One of the things that could come from this is that the clinic is going to identify people who need an assessment for substance use ...” she said. “We get very few of them now.”
The three organizations have been meeting for the past few months, but there’s still plenty of work ahead, officials say.
“It’s really a year-long planning effort to get us all on the same page, recognizing a common problem,” Fedrizzi said.