Accurate documentation and using the right diagnostic and procedural codes can help identify opioid overdose and adopt preventive measures.

1. Rise in Opioid Overdoses – Prevention
Strategies
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2. Over the past two decades, opioid overdose has become a major public health
problem in the United States and a leading cause of injury or death among
people. As per reports from the Centers of Disease Control and Prevention
(CDC), about 43,982 drug overdose deaths were reported in the United States
in the year 2013. It is estimated that every day in the US, 114 people die as a
result of drug overdose and another 6,748 are treated in emergency
departments for the misuse or abuse of drugs. Nearly 9 out of 10 poisoning
deaths are caused by drugs (both illicit and prescribed).
Overdose can happen to both men and women of all age groups, ethnicities
and demographic and economic characteristics. Opiates include illicit drugs
like heroin and prescription opioid analgesics such as oxycodone,
hydrocodone, fentanyl, and methadone among others. Overdose can happen
when a patient intentionally misuses a prescription opiate or an illicit drug. It
can also occur when a patient consumes the medicines (as directed by the
physician), but the prescriber miscalculated the dosage or a mistake was
made by the dispensing pharmacists or directions for use was misunderstood
by the patient. Problems can also occur when a person combines opiates
(prescribed or illicit) with alcohol, other medications or over-the counter
products that may cause problems in breathing, lower heart rate and other
functions of the central nervous system.
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3. How to Prevent Drug Overdose – Physicians’ Role
Physicians and healthcare providers play a crucial role in preventing the cases
of drug overdose. Before treating new patients, physicians need to evaluate
the patient’s medical history including the current and past use of medicines,
types of medicines consumed, dosage and frequency of use and route of
administration. In addition, they should enquire about the use of alcohol or
tobacco and over-the-counter (OTC) preparations.
On the other hand, people with mental health problems or with histories of
substance abuse should be given special attention by pain management
physicians. In such cases, medication-assisted treatment combined with
regular counseling and other supportive services may help patients to lead a
healthier life. Moreover, regular follow-ups at least once in 1-2 months may
also help prevent future risks.
PDMP (State Prescription Drug Monitoring Programs) have surfaced as a key
strategy in addressing the problem of misuse and abuse of prescription
opioids and thus preventing overdoses and deaths. With this program,
prescribers can easily check their state’s PDMP database and verify whether a
patient is filling the prescriptions provided and obtaining the correct
prescriptions for the same or similar type of drug from different physicians.
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4. It is important for healthcare providers and physicians to regularly update
their knowledge about evidence-based practices for the use of opioid
analgesics for pain management and take specific steps to reduce cases of
overdoses.
Accurate documentation of diagnoses and provided services using appropriate
diagnostic and procedural codes is vital both from the point of view of
patient care and from that of obtaining due reimbursement via accurate
medical billing.
The following ICD-9 codes are used to report opioid overdose –
 E850.1 - Accidental poisoning by methadone
 E850.2 – Accidental poisoning by other opiates and related narcotics
 E935.1 - Methadone causing adverse effects in therapeutic use
 E935.2 - Other opiates and related narcotics causing adverse effects in
therapeutic use
 E980.0 - Poisoning by analgesics, antipyretics, and antirheumatics,
undetermined whether accidentally or purposely inflicted
 965.0 - Poisoning by opiates and related narcotics
 E850.0 - Accidental poisoning by heroin
 E935.0 - Heroin causing adverse effects in therapeutic use
High Opioid Doses Linked to Increased Depression –Finds Study
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5. A new study reports that patients taking higher doses of opioid medicines to
manage chronic pain are more likely to experience an increase in depression
over time. The study conducted by researchers at the Saint Louis University
was published in Pain, the Journal of the International Association for the
Study of Pain (February 2015 edition). The study expands the researchers’
findings in a previous study of Veterans Administration (VA) patients.
Generally, depressed patients over time consumed more opioids. Researchers
wanted to identify whether this high-dose usage was one of the primary
reasons why pain patients experienced higher rates of depression. They
studied more than 355 primary care patients (mainly white and middle-aged
women) being treated for chronic low back pain (at nine clinics across the
Residency Research Network of Texas). The patient levels of depression along
with pain, anxiety, health-related quality of life and levels of stress and social
support were self-reported at baseline and at 1-2 years of follow-up.
The patients who were surveyed included 72.4 percent female, older than 46
(75.2 percent) and mostly of Hispanic or African-American descent (57.5
percent). In addition, they reported the total number of years they had
suffered acute pain.
Researchers collected information on opiate type and usage and comorbid
conditions from patient records. This was done to primarily assess the direct
association between changes in the opiate dosage (0, 1-50 mg, and greater
than 50 mg daily) and probability of depression over time, as well as the
change in depression levels and the odds of increased opioid dosage.
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6. It was found that better understanding of temporal relationship between
opioids and depression and dosage of the opioids (that places the patients at
higher risk for this condition) may help physicians in better prescription, pain
management and improve outcomes for patients suffering from debilitating
pain. Researchers consider that treating depression or reducing morphine
equivalent dose (MED) may mitigate a bi-directional association and
eventually improve pain management.
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