Recent estimates from the CDC have shown a slight shift in drug overdose deaths for the first time in 30 years, with those figures dropping from around 70,200 in 2017 to 68,500 in 2018. Although the decline may be a sign of hope, the overdose rate is still very high, and has a considerable impact on the Native American population.
A recent federal investigation from the Office of Inspector General (OIG) suggested that a failure to follow opioid prescribing and dispensing guidelines at Native American hospitals may be a contributing factor to the opioid epidemic, and elevated the risk of drug abuse and overdose among the Native American population.
“Our recently issued report continues to find deficiencies in IHS [Indian Health Service] hospitals’ opioids prescribing and dispensing practices,” says Carla J. Lewis, director of grants and internal activities for the HHS Office of Inspector General. “For example, the IHS hospitals we reviewed did not always access state prescription drug monitoring programs prior to prescribing opioids to a patient or before filling a patient’s opioid prescription.”
Health Facilities Lax in How They Handle Opioids
Government officials reviewed procedures at five IHS hospitals, drawing on a sample of 150 patients records.
Investigators noted that hospitals did not always review the course of patient treatment and causes of pain within required timeframes. Opioid doses were often exceeded, and sometimes doctors prescribed opioids and benzodiazepines together, which can be deadly, according to Chess Health.
“Combining opioids and benzodiazepines can be dangerous because both types of drug sedate users and suppress breathing — the cause of overdose fatality — in addition to interfering cognitive functions,” according to the National Institute on Drug Abuse.
Furthermore the OIG found that pain management documents were not always maintained, and IHS hospitals did not fully use the states’ prescription drug monitoring programs when prescribing or dispensing opioids.
Lewis pointed to several specific areas where systems were lacking — 105 out of 118 patient records did not contain informed consent, 79 out of 118 patient records did not contain a chronic opioid therapy agreement, and 27 out of 118 patient records did not show that urine drug screening had been performed every 6 to 12 months.
“We made several recommendations to IHS, including that they work with IHS hospitals to ensure the hospitals follow the Indian Health Manual when prescribing and dispensing opioids, and analyze opioid data to identify risks in opioid prescribing and dispensing practices,” says Lewis. “We also recommended that IHS revise the Indian Health Manual to include the type of action a provider should take and what documentation to include in the patient’s electronic health record when a urine drug screening is unfavorable.”
A Plague on the Nation
According to the National Institute on Drug Abuse, the overdose death rate has more than quadrupled since 1999. CDC statistics show that the opioid epidemic has hit the Native American and Alaska native population especially hard. This group had the second-highest rate of opioid overdose out of all U.S. racial and ethnic groups in 2017.
The CDC, American College of Physicians, and other health organizations have attributed a lot of the crisis to overprescribing. The total number of prescriptions dispensed peaked in 2012 at more than 255 million and a prescribing rate of 81.3 prescriptions per 100 persons, according to the CDC. More than 11 million people abused prescription opioids in 2016.
In an interview published July 22, 2019, by the Associated Press, Navajo Nation President Jonathan Nez has called the results of the report “very concerning.” He has reached out to IHS and Congress to address the issue.