Julia Montag: What we're doing and where we're going

Thursday, July 26, 2018 - 1:10pm

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This is Part 3 of Julia Montag’s three-part series about how the opioid crisis affects campus. Part 1 was an interview with Mary Jo Desprez, director of Wolverine Wellness, about the importance of educating the student body on prescription pill misuse and Part 2 discussed the resources available on campus for those struggling with both overdose and addiction.

 

As covered in Part 1 of this three-part series, a look at nationwide opioid overdose data led me to question the presence of an epidemic here at the University of Michigan, and, upon investigating, I was confounded by shockingly low numbers. The 2016 University of Michigan National College Health Assessment shows 98.5 percent of respondents answering “never” when asked about the frequency of their opiate use. Michigan is not the only campus that the opioid epidemic has skipped, Grace Bird says for InsiderEd. University of Wisconsin-Madison recently instituted an agreement with pharmacy chain Walgreens to allow students to buy overdose-countering Narcan, even though opioid misuse at the school is “exceptionally rare,” Bird writes. Like the University of Michigan, the University of Tennessee-Knoxville has a police department that stocks Narcan; U-M officers have only needed to administer it twice, which is two more times than needed in Knoxville.

“I would agree with the general observation, one supported by the NCHA data, that the campus community has largely been spared by the dramatic rise in opioid use compared to the general population,” Robert Ernst, medical director of U-M University Health Service, says. But if the entire country is being hit with the serious crisis that is addiction to prescription pain relievers, what’s keeping the numbers so low on many campuses?

 

Colleges have avoided the rise in drug use, Bird claims, because the epidemic “discriminate[s] in terms of education, as it disproportionately affects poorer, more rural and less-educated communities.” She explains the research that connects individuals with lower educational attainment to scarce, dangerous job opportunities — opportunities that increase the risk of workplace injuries and make use of an opioid painkiller likely.

 

Now, I am no doctor, but my extensive digging within the drug discussion showed me one important factor that college campuses have in common: Schools across the country are continuously pumping out novel, influential studies that work to combat the crisis. An immense amount of research takes place at these educational hubs, including  Ohio State University, University of Miami, University of Maryland — the list goes on — and I’d go as far as to say that this research is what’s suppressing addiction within this subpopulation. Universities are assembling vast resources to prevent and intervene upon addiction, as well as promote treatment and recovery. Perhaps sheer proximity to this information is what’s subduing addiction at the student level.

 

To corroborate this theory, I took a look into Michigan Medicine through a specific and inquisitive lens: What exactly is it about our university that keeps us from misusing? I found that the University of Michigan has assembled some brilliant minds, and they’re at the forefront of the crisis with power, intelligence and innovation. Schools around the country are citing the University’s groundbreaking studies to create the foundations of their programs. We have the safety nets and safety blankets of Wolverine Wellness and the CRP, just as we have the recovery-safe housing and medication disposal programs; we also have some of the country’s leading experts on drug misuse, and they’re working to revolutionize the way that the entire country tackles the crisis.

 

Among those professionals is Sean Esteban McCabe, an “internationally recognized scholar” and former director of the University of Michigan Substance Abuse Research Center. McCabe is rolling out studies that focus on the trends of prescription opioid use among U.S. adolescents and college students by analyzing motives, methods of administration and symptoms of disorder. In his study that attempted to clarify when and why people begin to misuse drugs, McCabe found that “most adolescents become fully responsible for their own medication management for the first time in their lives during college and are presented with more opportunities for — and a higher expectation of — substance use.” It’s possible that his work has so powerfully aided in our understanding of why this crisis began that it sparked other campus programs and projects that mitigate concerns and take control of addiction.

 

Exhibit A: the Opioid Overdose Summit in 2015, hosted by the U-M Injury Prevention Center, which assembled folks around the community and started important conversations surrounding the growing epidemic. The University also participated in the 2018 Opioid Abuse & Heroin Overdose Solutions Summit, where various doctors and residents presented on their specialties within the field. We have invaluable tools manufactured by our medical professionals and students, including the Michigan-made Opioid Prescribing Recommendations for Surgery. The website, of use to all patients in any hospital, provides new, lower recommended dosages of different painkillers for different surgeries and procedures. “(W)hen patients are prescribed fewer pills, they consume fewer pills with no changes in pain or satisfaction scores,” the site reads. The suggestions were developed by Michigan OPEN, or the Opioid Prescribing Engagement Network, which was established in 2016 with support from the Institute for Healthcare Policy and Innovation at the University of Michigan. Using patient-reported data, researchers found that previous recommended dosages swamp patients by meeting and oftentimes exceeding self-reported use, as discussed on the website.

 

Ernst explained to me yet another feature of our health system that fortifies proper prescribing efforts: changes implemented to the prescribing functionality of the common electronic health record system shared between UHS and the academic medical center. The advantages of those changes, rolled out just over the past few months, include a “single-click sign-on to the Michigan Automated Prescription System which provides for review by the prescriber a detailed report of all previously filled controlled substance prescriptions by that patient,” Ernst explained. “… No prescriptions for controlled substances, new or renewal, can be completed now without the provider first attesting to the fact that the MAPS report has been reviewed.” In addition to this detailed list, information packets that outline risks of overdose and dependence are now automatically provided for patients filling new prescriptions. Additionally, “for acute pain, the duration of prescribed opioids is limited to a maximum of seven days in order to prevent the occurrence of leaving unused pills,” Ernst said. Together, these novel features are paving the way for other medical centers to counter the norm and make new rules.

 

So what is it that keeps campuses from misusing? I believe it’s the McCabes, the Injury Prevention Centers, the thought-provoking summits and recommendations, and the consequential organizations that marshal vast troops of affiliates to exchange ideas and confront community issues head-on. I believe we fortunately live in a community where these influences are within reach.

 

 

So what is it that keeps campuses from misusing? I believe it’s the McCabes, the Injury Prevention Centers, the thought-provoking summits and recommendations, and the consequential organizations that marshal vast troops of affiliates to exchange ideas and confront community issues head-on. I believe we fortunately live in a community where these influences are within reach.