Joint Commission Enhances Substance Use Disorders Standards

IN A NUTSHELL:

• Total of eight standards
• 14 new and revised elements of performance
• Effective July 1, 2020
• Concern about opioid abuse from NIDA due to COVID-19

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The Joint Commission has introduced new and revised standards for behavioral health care organizations that treat substance use disorders, effective July 1, 2020.

The standards include 14 new and revised elements of performance (EPs) to improve the quality and safety of care for individuals seeking treatment, which focus on the following topics:

• Thorough assessments addressing key aspects of the individual’s history
• Placing the individual in an appropriate level of care
• Treatment and discharge planning
• Collecting toxicological specimens
• Safety measures for those on medication assisted therapy
• Disclosure of estimated costs for program

In order to prepare health care organizations to meet these standards, The Joint Commission issued a new R³ Report (.pdf) that provides the requirement, rationale and reference for each EP.

In addition to compiling data from an extensive literature review and public field review, The Joint Commission obtained guidance from experts in substance use disorder treatment and established a Standards Review Panel. The panel is comprised of clinicians and administrators who provided insights into the practical application of the standards.

The prepublication version of the standards is available online until July 1, 2020. After that date, the new requirements may be accessed in the E-dition or standards manual.

COVID-19 And Substance Use Disorders:

In March of this year, the National Institute on Drug Abuse called for the research community to be on alert to the possibility that as people across the United States and the rest of the world contend with the coronavirus and the effects of COVID-19, some populations with substance use disorders could be hit particularly hard. The opioid crisis in particular is receiving attention. People with opioid use disorder (OUD) may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health, which is concerning since the coronavirus that causes COVID-19 attacks the lungs.

Nonetheless, between 21% and 29% of patients prescribed opioids misuse them.

Healthcare professionals are faced with a difficult task. Their patients need pain relief and opioids are often their only option. But opioids are also addictive, and patients can develop a tolerance. If medical professionals don’t prescribe more or increase their dosage, their patients could try and purchase their medication illegally.

Understanding the opioid epidemic can be difficult but it’s necessary for patient safety.

Different Opioids and Their Potency

There are many different opioids. Some of the most common ones include:

• Hydrocodone
• Oxycodone
• Morphine
• Fentanyl
• Hydromorphone
• Codeine
• Methadone
• Meripidine
• Oxymorphone Hydrochloride
• Carfentanil
• Tramadol
• Buprenorphine

These opioids all have different potency levels. The most potent opioids that cause the most deaths are oxycodone, methadone, and hydrocodone. In addition, medical professionals need to worry about illegally manufactured fentanyl.

Oxycodone

Oxycodone, best known by the brand name OxyContin, is a commonly prescribed pain reliever. It’s prescribed to treat moderate to severe pain.

Because of its potency, long-term prescriptions need to be closely monitored.

Oxycodone is a narcotic. It’s highly addictive and long-term use increases the chance of overdosing and death. Risks also increase if you use oxycodone with alcohol and other prescription medications.

Oxycodone also comes with dangerous side effects. One of them is slowed down breathing, which is why oxycodone shouldn’t be prescribed to the elderly or patients with breathing problems.

Pregnant women also shouldn’t take oxycodone, to prevent the fetus from becoming dependent on the drug.

Hydrocodone

Hydrocodone is another highly addictive opioid, especially for those with a history of substance abuse addiction. Hydrocodone is commonly prescribed for severe pain, making it one of the most potent opioids. Most hydrocodone prescriptions aren’t refillable. This drug also comes with life-threatening side effects.

Methadone

Methadone is a prescription that treats both pain and prescription painkiller addiction. Unfortunately, methadone is also a highly addictive substance. Those who are prescribed methadone for prescription drug addiction relief are often prescribed methadone during a detox program, under the supervision of medical professionals. Because of this, many patients become addicted to methadone, increasing the risk of overdoses and fatalities.

Methadone also comes with serious side effects, such as breathing problems. These risks increase if you take other drugs and drink alcohol alongside methadone. Pregnant women shouldn’t take methadone nor should those with heart conditions.

The Opioid Crisis and Priorities Medical Professionals Should Take

Because the opioid crisis is so prevalent, medical professionals have many responsibilities:

Promoting the use of overdose-reversing medications: Naloxone is a perfect example; it can block the effects of opioids.

Improve access to treatment and recovery: In case a patient becomes addicted, they will have improved and affordable care options for drug treatment as well as a mental health treatment.

Know the latest research on pain and addiction: This includes the latest statistics on prescription drug abuse, the drugs that are commonly misused, and any new side effects.

Understand the scope of the crisis: Know why patients become addicted and how to reduce the effects when opioids need to be prescribed.

Know other pain relief options: This includes less potent over-the-counter pain relievers and holistic pain relief methods.

Take opioid courses: There are CME courses that better increase a medical professional’s knowledge of opioids and their long-term effects.

Know the Addiction Risk Factors

Not all pain patients will fall victim to painkiller addiction. But some risk factors increase a patient’s chance of addiction. Some of the most common risk factors include:

• Taking a higher dosage and/or long-term prescription length
• A patient who takes multiple prescription medications along with painkillers
• A history of mental illness or substance abuse

What should you do with these high-risk patients who need pain relief? Medical professionals may face legal issues if they prescribe opioids to high-risk patients. To address their needs, offer effective pain relief alternatives. If this doesn’t work, prescribe the lowest dose of painkillers. Refer the patient to an addiction specialist, if necessary.

Opioid Statistics to Know:

• 66% of overdose-related deaths are caused by opioids
• One in four patients prescribed opioids struggle with addiction
• Opioid sales and opioid-related deaths have quadrupled since 1999
• 115 people die every day from opioid overdose
• Between 4% and 6% of patients who misuse opioids transition to other drugs, such as heroin

It’s a medical professional’s job to only prescribe opioids when it’s necessary, to prescribe a minimum dosage, and avoid prescribing high-risk patients.

How Can Medical Professionals Help Those With Opioid Addictions?

There are many actions that healthcare workers can take to help those with opioid addictions. It’s important to never be judgmental and always show support for your patients. Be compassionate and understanding about their addiction and their pain, both physical and mental.

You should always know how to treat their addiction and offer specialized assistance when it’s necessary. It’s also helpful to promote holistic pain relief to prevent addiction. What if one of your patients beat opioid addiction? Congratulate them and show your support. Continue encouraging patients to recover and prevent relapsing.

To improve your knowledge of opioid addiction, it’s recommended all medical professionals take opioid CME courses to better understand opioids and how you can better assist patients.

How to Prevent Opioid Addiction

Ensure your pain management program is safe and effective. Only use opioid treatment as a last resort; for example, only prescribe opioids for post-op pain and any condition where the patient experiences daily pain for three months.

Always prescribe the lowest dose and try to avoid potent opioids. If necessary, use a drug monitoring program. This ensures patients are misusing or abusing drugs. If they are, medical professionals can take necessary actions. Educate patients about addiction and make overdose prevention more accessible; for example, make Naloxone available to first responders and educate medical emergency staff on how to administer the medication.

Knowing the long-term effects and dangers of opioid use will also better prevent opioid addictions. Medical professionals can take opioid CME courses to improve their understanding of opioids.

Understanding the Opioid Epidemic for Medical Professionals

We are currently in the middle of the opioid crisis. Understanding the opioid epidemic and how to fight it can be difficult. But medical professionals have many tools to help their patients.

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