Connecticut saw one of the highest increases in the nation in preventable deaths from unintentional injuries from 2010 to 2014, mainly because of a spike in opioid overdoses, according to a new report from the Centers for Disease Control and Prevention (CDC). An analysis of the report shows that the state’s rate of potentially preventable deaths from accidental injuries jumped 97 percent – the sixth- highest increase nationally, after Maryland, Massachusetts, New Jersey, New York and Virginia. Nationally, preventable deaths from accidents – namely, overdoses from prescription and illicit drugs, as well as falls – rose 23 percent. Connecticut had 1,142 unintentional injury deaths in 2014— the second highest in New England, after Massachusetts. About half (568) were accidental drug intoxication deaths, according to the Office of the Chief Medical Examiner.
More than 60 medical experts, state health directors and advocacy groups have asked federal Medicare officials to remove questions related to pain treatment from hospital patient surveys that are used to rate hospital quality, saying such questions “have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.”
In a letter to Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), the group said “aggressive management of pain should not be equated with quality healthcare, as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids.” The coalition asked that CMS survey questions such as “During this hospital stay, how often was your pain well controlled?” be removed. The group sent a similar letter to the Joint Commission, which accredits U.S. hospitals, asking that it revise its pain management standards – specifically, guidelines directing doctors to ask patients to assess their pain, as they assess other “vital signs.”
“Mandating routine pain assessments for all patients in all settings is unwarranted and can lead to overtreatment and overuse of opioid analgesics,” they wrote. The letters come as Connecticut and other states grapple with a surge in opioid-related overdoses. Last week, U.S. Sen. Richard Blumenthal, D-Conn., joined several other senators to support a bill that would factor-out the pain-related questions on patient surveys from hospitals’ Medicare reimbursement determinations. Meanwhile, at the state legislature, the Public Health Committee has proposed a bill that would cap initial prescriptions of opioids to seven days for acute pain.
A Derby nurse practitioner was among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 – an anomaly in a state where Medicare records show nurse practitioners rarely prescribe such drugs, which have a high potential for abuse. Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, wrote out 8,705 prescriptions for opioids and other Schedule II drugs in 2012 – the most prolific prescriber among all Connecticut practitioners, including pain specialists and other physicians, according to Medicare data compiled by ProPublica. She wrote out more prescriptions for the opioid Exalgo than any other Medicare provider in the country, and was the seventh highest prescriber nationally of Oxycontin, writing out more than twice as many prescriptions for that narcotic as the next highest prescriber in Connecticut. She also was the 10th highest prescriber nationally of Avinza, a morphine product. There is no indication that Alfonso’s unusual prescribing frequency drew scrutiny from state or federal officials.