As the death toll for opioid-related deaths climbs throughout the United States, El Camino Hospital officials say they're doubling down on ways to control the problem on a local level by keeping a close watch on prescription painkillers and offering more services for patients suffering from chronic pain.
Opioid addiction and overdoses have turned into a leading cause of accidental deaths in the United States, surpassing car accidents in 2008, with a staggering 91 Americans dying every day from overdose, said Dr. William Faber, El Camino's chief medical officer. Speaking at a hospital board meeting last week, Faber said that while the over-prescribing of opiates is seen as the biggest cause for the epidemic, street drugs like heroin are cheaper than they used to be, and can be more lethal when laced with the synthetic narcotic Fentanyl.
While Santa Clara County's opioid-related death rates have been fairly low compared to the rest of the country and the state, it's still a local problem worth addressing, he said. State data tracking the opioid epidemic shows that 66 people died of opioid overdose in Santa Clara County in 2016, slightly higher than neighboring San Mateo and Alameda counties when adjusted for population. That same year, the number of opioid prescriptions in the county surpassed 700,000, more than one for every three residents.
Although local death rates change dramatically each year, the 94041 zip code region that encompasses Old Mountain View had the highest death rate in the county in 2015, with just over 19 opioid deaths per 100,000 residents. Given the region's small population, that amounts to three deaths.
El Camino Hospital's plans center around strong accountability and tracking of narcotic drugs. Faber said the hospital has an in-house system that keeps track of every dose of painkillers that doctors and nurses administer to patients, giving El Camino an effective way of catching any staffer who may be misappropriating opioid drugs. This is particularly important for substances like Fentanyl, he said, which can be processed into dangerous street drugs.
The hospital also hired a so-called pain pharmacist over the summer, whose role is to help doctors address pain through non-narcotic drugs and methods like physical therapy that are more safe and just as effective. For example, the pharmacist might recommend a drug like Toradol in lieu of opioids for a patient with a kidney stone, Faber said.
Although the pain pharmacist plays an important advisory role in the way the hospital handles chronic and acute pain during patient visits, as well as over prescriptions for discharged patients, it's ultimately up to each physician to decide what drugs to prescribe.
Hospitals aren't the primary culprit for the opioid problem, which admittedly limits the role they play in reducing the problem, Faber said. Most of the painkillers being prescribed are from outpatient care providers for people suffering from chronic pain, whereas patients in the hospital often rely on strong narcotics -- appropriately -- for recovery from surgery and other major procedures. It's once patients leave the hospital and continue to seek out the drugs that an addiction problem arises.
"When people go out into the outpatient realm, we've got some doctors who are loosely prescribing inordinate amount of drugs for people with back pain or a headache when it's inappropriate," he said. "Despite the fact that it's mainly an outpatient problem, there are a number of things we do here at the hospital to do our part."
One of the ways narcotics can make it out of the hospital and onto the streets is through the emergency department, prompting El Camino to adopt strict policies for giving out drugs to patients who might be feigning an illness in order to get their hands on drugs like Vicodin. Faber said the emergency department does not prescribe strong narcotics just because patients ask for them, and the default is to give people no more than 15 tablets of Norco, a relatively mild opioid.
In order to cut out the middle man and reduce the chances of a forged prescription, hospital officials are planning to open El Camino's own outpatient pharmacy off of the main lobby in May which would allow patients to get their prescriptions filled on the spot before leaving. It won't be a money-making venture and would likely break even, Faber said, but it does mean fewer people will be in the "chain of custody" for each prescription that leaves the hospital.
"Mischief happens when people leave the building with a prescription or it's electronically sent off premises," he said. "Sometimes people play games with that or alter the prescription. When I was prescribing narcotics if I said '10 Vicodin,' on numerous occasions someone would try to put another zero on it and turn it into 100."
Board member Peter Fung, a neurologist, said the hospital needs to change the the mentality of the physicians at El Camino and encourage them not to spring for opioids whenever a patient is feeling pain. In many cases, over-the-counter drugs like Tylenol are often just as effective as the opioid Percocet. At the same time, he said, the hospital needs to improve its addiction and behavioral health services for the patients who are already addicted to narcotics and need help.
The hospital currently provides addiction services including weeks-long outpatient program for adults struggling with drug abuse. One of the two outpatient programs, the Dual-Diagnosis Program, is an intensive program for patients suffering from severe addiction to drugs including opiates and stimulants as well as "co-occurring" mental health disorders, according to Dr. Evan Garner, director of the hospital's addiction services programs.
Garner said the Dual-Diagnosis Program runs five days a week for six hours a day, and is considered one step down from 24-hour in-patient care or an acute psychiatric setting.
Rebecca Fazilat, chief of staff at El Camino's Mountain View campus, told board members that addressing the opioid crisis means suspension of judgment against people who are suffering from addiction, many of whom are struggling from real pain and didn't choose to get addicted to painkillers.
"They are seeking the only help they know that they can get," she said. "It behooves us not to judge them and kick them out the door."
At the same time, Fazilat urged against vilifying all of the outpatient physicians who prescribe painkillers. There are few pain specialists and other pain management resources available in the area, and primary care doctors are often inundated with so many other obligations that it becomes tempting to just hand out a prescription.
"As much as we like to judge folks for dishing out a prescription, if they know their patient is in pain and it's an easy thing to do, that's often why it happens," she said.