A public health and public safety partnership program in New York City called RxStat is using data from different government agencies to pinpoint opioid overdoses and to make changes to reduce the toll of prescription drug abuse. The goal is to reduce overdose deaths and to drive home the message that opioid overdose deaths are preventable.
RxStat is housed at the New York City Department of Health and Mental Hygiene (Health Department). It involves timely analysis of drug misuse indicators from multiple data sources, according to Dr. Denise Paone, Director of Research & Surveillance Bureau of Alcohol & Drug Use Prevention, Care & Treatment at the New York City Department of Health and Mental Hygiene. “If you have timely data, you can find emerging issues and respond rapidly,” she says.
The data includes emergency room visits to city hospitals for opioid overdoses, Fire Department and Emergency Medical Services calls about overdoses, deaths due to opioids, prescription data from the state, and information from the Drug Enforcement Administration and the Manhattan District Attorney’s Office.
“If we see an increase in opioid activity in certain neighborhoods, we’ll go out to those communities and get more data,” Paone says. “Then we’ll respond with programs and initiatives.”
When the RxStat staff looked at the data, they saw rates of opioid overdoses were three times higher in Staten Island compared with the city’s other boroughs. Staten Islanders filled prescriptions for opioid painkillers at higher rates in 2012, had a longer median day supply, and were more likely to have high-dose prescriptions, compared with the city’s other boroughs.
“We took a comprehensive approach. We conducted a ‘detailing’ campaign visiting 1,000 physicians, nurse practitioners and physicians’ assistants to explain judicious prescribing, and conducted follow-up visits with most of them,” she notes. The campaign included one-on-one visits from Health Department representatives who delivered key prescribing recommendations, clinical tools and patient education materials.
Doctors were advised to avoid prescribing opioids for chronic non-cancer, non-end-of-life pain, such as for low back pain, arthritis, headache or fibromyalgia. They were told that when opioids are warranted for acute pain, a three-day supply is usually sufficient. They were also urged to avoid whenever possible prescribing opioids in patients taking benzodiazepines.
The Health Department produced public service announcements to increase awareness of the risk of opioid analgesic overdoses. One ad featured a testimonial from a mother who lost her son to an opioid painkiller overdose, and another showed a New York City resident in recovery.
The staff also held meetings with community groups and conducted two forums with doctors on Staten Island. Paone and her colleagues are now evaluating the data, and will find out soon whether changes in doctors’ knowledge about opioids has translated into a decrease in prescriptions, and high-dose prescriptions in particular.
The program has expanded to other areas of the city. Last year the RxStat staff noted an increase in opioid-related deaths in Queens. “We held town hall meetings and we’ve been doing presentations with community groups,” Paone says. The program is now starting a campaign to visit doctors in the Bronx.
RxStat can be replicated in other areas, even in cities and towns with far fewer resources than New York, according to Paone. “They may not be able to reproduce every component, but they can obtain the data and do a detailing campaign.”
The program has released a technical assistance manual to explain how it works.