Recently, the Centers for Disease Control and Prevention reported 71,568 deaths in the United States from drug overdoses (CDC, 2018). These preventable deaths exceeded those from suicides, influenza, and pneumonia and were about half of accidental fatalities in the U.S. In epidemiology, we speak of a triangle with the points being a host, agent, and environment. In this case, its agent is not a microbe, but a human—and the environment can be a home, a classroom, a gym, or a park. The costs of this epidemic are in the billions in dollars and in millions in human lives affected by the disease. While anecdotes are heart-wrenching, politicians, corporations, and yes, healthcare organizations are driven by the bottom line: how much will it cost to slow down this epidemic? Where are the pressure points—host, agent, environment—where interventions can have the most effect? Who needs to be at the table to discuss local, state, federal, and international policies and programs? Just saying no isn’t an answer to this problem.
Like other epidemics, drug use and abuse do not respect ethnicity, education, class, or borders. As health care management educators, we have a duty to educate our students about the realities of caring for people with substance abuse disorders. We must also teach them how to participate in policy development to address this epidemic. We must give our students assignments that demand the use of critical thinking skills framing the opioid epidemic as a public health epidemic and putting the costs of the epidemic front and center. The best way to teach our healthcare management students these important lessons is not through passive approaches such as lectures, slide shows, or videos, but by providing them active learning experiences across the curriculum. The following are five (5) assignments to address the opioid epidemic.
Assignment for a Healthcare Financial Management Course
You are the director of the emergency department (ED) in a not-for-profit hospital in your state and the opioid epidemic has hit hard. On some nights, your ED looks more like the city morgue than a city hospital. Those who survive require various levels of treatment and support, “including overdose, injection-related concerns, and withdrawal” (CDC, 2018). Thirty percent (30%) of the ODs were between the ages of 24 and 34 years of age; twenty-five percent (25%) were between the ages of 35and 54 years of age, and twenty-five (25%) were 55 years old and over. Your insurance specialists have determined the following: 38% were on Medicaid, 37% had private insurance, 17% were uninsured, 3% were Medicare recipients over the age of 65, and the insurance status of the remaining patients was unknown. Based on a worst-case scenario, what should you tell your CFO about the losses due to the opioid epidemic? What recourse does your hospital have in light of this epidemic? What impact will this have on your future planning for your emergency department?
Assignment for an Epidemiological Management Course
Part A. Using the Henry J. Kaiser Family Foundation (KFF) data for the three (3) most recent years create a table of all United States (national level) drug-related overdose deaths for the following: All Drug Overdose Deaths, All Opioid Overdose Deaths, and Opioid Overdose Deaths as a Percent of All Drug Overdose Deaths. In your own words, provide an interpretation of the data for the last three years.
Part B. Using the Henry J. Kaiser Family Foundation (KFF) data for the three (3) most recent years, create a table using your state’s data for all drug-related overdose deaths for the following: All Drug Overdose Deaths, All Opioid Overdose Deaths, and Opioid Overdose Deaths as a Percent of All Drug Overdose Deaths. In your own words, provide an interpretation of the data for your state for the last three years. How do your state’s data compare with the United States (national level) data?
Part C. Provide three (3) reasons for why your state-level data in Part B may or may not be different from national-level data. Provide rationales for your assessment, along with appropriate references. Based on your answers to Part B, what kind of interventions do you think would be most effective for your state?
Assignment for a Healthcare Policy Course
Lobbyists are a fact of life in Washington, D.C. and many Pharmaceutical (Pharma) advocacy groups have contributed millions of dollars to members of our Congress. Using open sources information sites such as FollowTheMoney.org and OpenSecrets.org, find out if Pharma advocacy groups have contributed to your US Congressmen and Senators and how much. Contact each of your District’s Representatives and Senators (the ones for your zip code) and ask what their position is on: restrictions on access to opioids; use of alternatives (such as marijuana) for pain control; and the use of drug courts (juvenile, adult, family) to reduce relapse and recidivism. Create a table (name of Congressman, amount received, position on pharma issues) from this information and describe what the data are saying.
Assignment for a Leadership Course
Request an interview with a health care executive and explore her perceptions of the impact of the opioid epidemic on her organization. Ask to see the health care organization’s plan for addressing the opioid epidemic, specifically asking what partnerships the organization has with community groups to increase access to naloxone and to help persons with substance abuse and addiction and. Based on your interview and review of the plan, create a report on the organization’s preparedness. Provide rationales for your assessment, along with appropriate references.
Assignment for a Human Resources (HR) Course
Healthcare professionals are not immune to the disease of addiction. Set up an interview with a VP of HR in a healthcare organization and ask the following questions: if you have an employee who is addicted to opioids, what does HR do? What are the disciplinary steps? What resources do they offer to these employees? Who is responsible for the costs of these services? Using current (less than 5 years old) peer-reviewed articles, compare the policies and procedures at this organization with those recommended in the literature. Based on this review, what recommendations would you make to the VP of HR?
In conclusion...
As healthcare management educators, we are obligated to prepare our students to be responsive to their environment. By incorporating assignments by framing the opioid epidemic as a public health epidemic, we can prepare our students to be better healthcare managers.
Here are some additional resources if you are interested in this topic:
Centers for Disease Control and Prevention (CDC). (2018, March). Opioid overdoses treated in emergency departments. Retrieved from https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html
Centers for Disease Control and Prevention (CDC). (2018, March). Opioid overdoses treated in emergency departments: Infographic. Retrieved from https://www.cdc.gov/vitalsigns/opioid-overdoses/infographic.html#infographic
Centers for Disease Control and Prevention (CDC). (2018, August 15). National Center for Health Statistics (NCHS). Provisional drug overdose death counts. Retrieved from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Cox, C., Rae, M. & Sawyer, B. (2018, April 5). A look at how the opioid crisis has affected people with employer coverage. Retrieved from https://www.healthsystemtracker.org/brief/a-look-at-how-the-opioid-crisis-has-affected-people-with-employer-coverage/#item-start
Crane, E.H. (2017, November 30). Emergency department visits involving the accidental ingestion of opioid pain relievers by children aged 1 to 5. Retrieved from https://www.samhsa.gov/data/report/emergency-department-visits-involving-accidental-ingestion-opioid-pain-relievers-children
Drug Policy Alliance. (n.d.) Promoting a health approach to drugs. Retrieved from
http://www.drugpolicy.org/california/promoting-health-approach-drugs
Henri J. Kaiser Family Foundation (KFF). (2018). Opioid overdose deaths and opioid overdose deaths as a percent of all drug overdose deaths. Retrieved from
https://www.kff.org/other/state-indicator/opioid-overdose-deaths/ currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Kirson, N.Y., Scarpati, L.M, Enloe, C.J., Dincer, A.P., Birnbaum, H.G., Mayne, T.J. (2017, April).The economic burden of opioid abuse: Updated findings. J Manag Care Spec Pharm, 23(4):427-445. Retrieved from https://www.jmcp.org/doi/full/10.18553/jmcp.2017.16265
Kuo, Y-F, Raji, M.A., Liaw, V, Baillargeon, J., Goodwin, J.S. (2018, April 14). Opioid prescriptions in older Medicare beneficiaries after the 2014 federal rescheduling of hydrocodone products. Journal of the American Geriatrics Society, 66(5), 945-953. Retrieved from https://doi.org/10.1111/jgs.15332
Mukherjeem S. (2018, August 15). U.S. drug overdose deaths rose to a record 72,000 last year, CDC says. Retrieved from http://fortune.com/2018/08/15/drug-overdose-deaths-cdc-record/
National Institute on Drug Abuse (NIDA). (2012, December 14). Comorbidity. Retrieved from https://www.drugabuse.gov/related-topics/comorbidity
National Institute on Drug Abuse (NIDA). (2017, May 4). Drug testing. Retrieved from https://www.drugabuse.gov/related-topics/drug-testing
National Institute on Drug Abuse (NIDA). (2017, June 15). Recovery. Retrieved from https://www.drugabuse.gov/related-topics/recovery
National Institute on Drug Abuse (NIDA). (2018). International program. Retrieved from https://www.drugabuse.gov/international
National Institute on Drug Abuse (NIDA). (2018, April). Opioid overdose reversal with naloxone (Narcan, Evzio). Retrieved from https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
National Institute of Justice (NIJ). (2018, August 23). Drug courts. https://www.nij.gov/topics/courts/drug-courts/Pages/welcome.aspx
Peterson-Kaiser Health System Tracker. https://www.healthsystemtracker.org
Substance Abuse and Mental Health Services Administration (SAMHSA). (2017, September 20). Behavioral health treatment and services. Retrieved from https://www.samhsa.gov/treatment
Substance Abuse and Mental Health Services Administration (SAMHSA). (2017, September 20). Recovery and recovery support. Retrieved from https://www.samhsa.gov/recovery
Substance Abuse and Mental Health Services Administration (SAMHSA). (2018, May 29). Prevention of substance abuse and mental illness. Retrieved from https://www.samhsa.gov/prevention
US Department of Health and Human Services (HHS), Office of Inspector General (OIG). Opioids in Medicare Part D: Concerns about extreme use and questionable prescribing. HHS OIG Data Brief OEI-02-17-00250. Retrieved from https://oig.hhs.gov/oei/reports/oei-02-17-00250.pdf
US Department of Justice (DOJ), Office of Justice Programs. (2018, May). Drug courts. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/238527.pdf
Velshi, A. (2018, August 16). The opioid crisis we still have a lot to do. MSNBC. Retrieved from https://www.msnbc.com/ali-velshi/watch/the-opioid-crisis-we-still-have-a-lot-of-work-to-do-1300537411537
About the Author
Sharon Buchbinder Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.