In 1995, Oxycontin was introduced by Purdue Pharma and aggressively lobbied as a “safe” pain pill. Since that time, Oxycontin and many other opioids have been the cause of countless deaths in the United States with over 67,000 drug-related deaths in 2018. Deaths from prescription drugs such as Oxycontin alone are more frequent than both cocaine and methamphetamine combined.

One of the states most affected by this crisis is Rhode Island. Despite only having a population of ~1 million, the number of opioid deaths per capita is 20% higher than the national average. In most cases of any drug-related death, the victim had previously overdosed multiple times. Overdose victims are sent to the hospital, which will only provide them with treatment for their physical overdose and not their addiction. Aproximately 46% of those who enter drug rehabilitation remain sober while another 16% check themselves into rehab again later on. Even without remaining sober, the risk of death from overdoses drops even further. So, how can we ensure those who are hospitalized with an overdose and survive receive the life-saving treatment they need?
The best option is through referrals. The hospital system in Rhode Island operates on a fee-for-service budget. For every person who comes in, their insurance is billed, and the hospital is paid. States like Maryland, for example, operate on a fixed budget system where they save money the fewer patients they treat. Both systems have benefits and drawbacks but a major drawback of the R.I. system is that hospitals have no incentive to refer overdoses to rehabilitation centers. Everytime someone overdoses it adds to the number of services the hospital has provided and increases their budget. The challenge, then, is getting hospitals to refer patients to rehabilitation centers even when it is not in their best interests. Additionally, pharmaceutical companies have been known to lobby against any change that might disrupt the flow of opioids sales despite the countless deaths they are responsible for.
In order to enact this type of policy the support of other important stakeholders is key. The Drug Overdose Prevention and Rescue Coalition (DOPRC), for example, was established by the Rhode Island department of health in 2012 to fight the opioid crisis by developing evidence-based policy to prevent opioid addiction and death. Enacting a policy of automatic rehab referrals in RI hospitals could not only prevent deaths, but also put many victims of the opioid crisis on the path to recovery.