According to a new report from the Department of Health and Human Services (HHS) Office of Inspector General, hospitals may be putting Native American patients at increased risk for both opioid abuse and overdoses. The report sheds light on the fact that these hospitals aren’t following their own protocols for how they prescribe and dispense opioids. The federal audit was made public in July 2019.
The report doesn’t indicate whether patients experienced suffering as a result of prescribing practices at Native American hospitals or how it could have contributed to specific instances of Native American drug abuse. What it does do is call for changes at Indian Health Service hospitals.
The Opioid Epidemic Among Native Americans
According to Carla Lewis, who spoke to the Associated Press and was one of the auditors who worked on the report, there is a particular level of vulnerability among Native Americans. The opioid epidemic has killed more people than any other drug epidemic in the history of the United States, and it’s hit Native American communities especially hard.
The Centers for Disease Control and Prevention reports American Indian and Alaska Native populations had the second-highest death rates from opioid overdoses in 2017. They experienced the second-highest overdose rates from heroin specifically and the third-highest from synthetic opioids like fentanyl.
The Native American opioid epidemic and Native American drug abuse statistics make the audit findings even more troubling, according to many including Navajo Nation President Jonathan Nez.
Hospitals Not Following Dispensing Protocol
Opioid overprescribing is often named as one of the causes of the opioid epidemic. The audit from HHS looked at five of the 25 hospitals directly operated by the Indian Health Service. Specific criteria auditors looked included the number of opioids prescribed at each hospital as well as the percentage increase over a three-year period. These were determining factors in deciding which specific hospitals to audit.
The Indian Health Manual outlines certain guidelines for the prescribing of opioids. For example, treatments must be reviewed, along with the causes of pain every three months. The Indian Health Manual also calls for patients to sign a written consent and agreement form, acknowledging they know the risks and benefits of opioids. CDC prescribing guidelines call for the equivalent of no more than 90 morphine milligrams a day.
The audit found that more than 100 patient records didn’t include evidence of consent that is required by the Indian Health Manual. It also found every hospital either met or exceeded the CDC prescribing guideline of no more than 90 milligrams of morphine a day or the equivalent.
At the Shiprock hospital audited, the daily dosage was more than four times higher than the recommendation, and auditors discovered some patients were being prescribed both opioids and benzodiazepines.
Risks of Overprescribing Opioids
There are many risks of overprescribing opioids to patients. Primarily there are the risks of dependence and overdose. If someone takes opioids, even as prescribed, they may become dependent and addicted. There is also the risk of an overdose because opioids slow the respiratory system and can lead to death.
When opioids are prescribed with another drug that also slows the respiratory system, the risk of overdose is even higher. That’s the case with opioids and benzodiazepines, which typically shouldn’t be prescribed together, yet the HHS audit found they were.
Dispensing Accountability To Improve in Reservation Hospitals
In light of the troubling audit findings, there are certain actions Indian Health Service hospitals need to put in place as part of their efforts to combat the opioid addiction epidemic. Now, following the audit, the Indian Health Service facilities have to submit all of their relevant data on opioid prescribing so it can be tracked.
Some of the things the Native American health centers will need to enact will include ensuring all patients sign informed consent forms and that there is an alert system to know when patients need to be screened for drugs after staring opioid treatment. Pharmacists will also have to review patient files before they fill prescriptions from outside health care providers, and more will need to be done in terms of safely securing opioids.
If you or someone you love is experiencing dependency on opioids or addiction, help is available. Reach out to The Recovery Village at Palmer Lake today to explore your treatment options and receive the care and help you deserve.
Fonesca, Felicia. “Elevated opioid risks found at Native American Hospitals.” AP News, July 22, 2019. Accessed October 11, 2019.
Department of Health and Human Services. “IHS Needs to Improve Oversight of Its Hospitals’ Opioid Prescribing and Dispensing Practices and Consider Centralizing its Information Technology Functions.” July 2019. Accessed October 11, 2019.
Indian Health Service. “Opioid Crisis Data: Understanding the Epidemic.” Accessed October 11, 2019.
Centers for Disease Control and Prevention. “CDC Guidelines for Prescribing Opioids for Chronic Pain.” Accessed October 11, 2019.
Centers for Disease Control and Prevention. “Data Overview: Overview of the Drug Overdose Epidemic: Behind the Number.” December 19, 2018. Accessed October 23, 2019.
Indian Health Service. “Chapter 30 – Chronic Non-Cancer Pain Management.” Accessed October 23, 2019.