New York | 50 states of population health

MITCHELL KATZ, MD. President and CEO of NYC Health + Hospitals (New York City)

On the top challenge

"Opioid addiction is the problem. We are prescribing buprenorphine not only in the outpatient areas but actually from the emergency department. So buprenorphine availability [is an issue], [along with] distribution of naloxone, not just to patients themselves who are at risk of overdose but to their families."

On the hospital's response  

"There's a wonderful program occurring under our aegis at [New York City jail] Rikers Island, where we're distributing naloxone in the family room to the relatives [of inmates]. We explain that when people leave incarceration, that is one of the highest risk times for overdose since people haven't used in jail because of a lack of [drug] availability. If they come out and attempt to use at a level similar to what they were using before they were in jail, there's high risk of overdose.

We're also working with providers to increase understanding that many patients get hooked to opiates quickly. Therefore, even small doses given to people undergoing surgical procedures can lead to opioid addiction. We're encouraging providers to use alternative, nonopioid medications or prescribe the minimum number of tablets to get somebody through a challenging postoperative period. We don't want patients to be in pain, but I think there's a much greater understanding based on research at several sites that patients who are prescribed what may seem like a very minimal seven-day course of opioids following a surgery, following a tooth removal, that those people — if you look a year later — are much more likely to be hooked on opioids. We know the person is uncomfortable, but is it worth the risk of that person having a lifelong addiction? No one ever promised life was without pain. It might be safer for people to be on a nonopioid medicine like ibuprofen. There's generally been a feeling that seven-day prescriptions are not a concern, but obviously there's something about our biology that make some seven-day prescriptions lead to longer term addiction."

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