While the world's attention to public health remains focused on COVID-19, Berkeley Franz, Ph.D., assistant professor at the Ohio University Heritage College of Osteopathic Medicine, continues to focus her attention on one of the largest public health crises in the United States today - the opioid epidemic.
Franz, along with Cory Cronin, Ph.D., assistant professor in OHIO's College of Health Sciences and Professions, and José Pagán, Ph.D., professor of public health policy and management at New York University, co-authored the article, "What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals," to identify what hospitals are doing to combat the opioid epidemic and how they could better address these problems in communities.
The study led by Franz is published in Public Health Reports, the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service.
Prior to the COVID-19 pandemic, the opioid epidemic was the most vexing health problem. High rates of addiction were cited as one of the main reasons that American life expectancy declined in multiple years, something we rarely see. At the same time, opioid misuse increased to be the greatest causes of preventable death. This study shows that hospitals can play a clear and important role in implementing interventions and effectively treating patients, especially if they are willing to do so on site."
Berkeley Franz, Ph.D., Assistant Professor, Ohio University Heritage College of Osteopathic Medicine
This study is part of ongoing research Franz is doing to understand whether hospitals are addressing the most critical public health needs in their communities. She is also studying institutional barriers to adopting new programs to address opioid misuse, including the presence of bias/stigma among health care professionals.
Through their research, Franz, Cronin and Pagán found that hospitals often don't do evidence-based programs despite evidence that treating the patient at the hospital rather than through a referral leads to more effective treatment and reduces death from subsequent overdoses.
"With opioid misuse, people often end up in hospitals for care, which is a great place to address other, secondary health consequences that come from the misuse," Franz explained. "Aside from an actual overdose itself, people can get infections at the injection site, heart and skin infections, infectious diseases linked to intravenous drug use and more. By taking care of these individuals in a hospital setting, medical professionals can also address these issues as well as introduce treatment for the underlying substance use disorder."
To compile data, the researchers analyzed data from a 20% sample of all U.S. hospitals to determine what they were doing to address opioid abuse.
The researchers looked at whether hospitals offered specific kinds of services - and specifically whether the hospitals were directly addressing the issue or redirecting patients to primary care or other outpatient care.
"While individual health needs assessments and implementation strategies are publicly available, our hope is that by aggregating strategies and trends, we can provide a snapshot of the overall picture, which may be helpful to decision makers in health care organizations or public agencies," Cronin said.
The study shows that nonprofit hospitals invest in clinical strategies and risk education, but they could do more by initiating medication-assisted treatment at the hospitals and adopting harm reduction initiatives, such as distributing naloxone or offering syringe exchanges.
"We have created a great partnership between Ohio University and New York University researchers interested in the contribution of hospitals to improve the health of our communities," Pagán said. "I am very lucky to have had the opportunity to work with this great team and bring awareness to the important leadership role hospitals play in our communities to help reduce opioid abuse."
Pagán added that state support is important, as hospitals are more likely to adopt harm reduction programs and other strategies in states that take the lead encouraging the use of these strategies.
Although some hospitals are adopting evidence-based strategies to address opioid misuse, the pandemic is affecting how hospitals can implement such programs effectively. For instance, many hospitals are currently focused on fighting COVID 19, so they may have fewer opportunities to offer substance abuse services. At the same time, the added societal stress of the pandemic can actually exacerbate substance misuse. Also, some hospitals do not offer direct services for those who misuse substances.
Franz, B., et al. (2020) What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals. Public Health Reports. doi.org/10.1177/0033354920968805.