How can AI and Analytics impact Opioid Monitoring and Surveillance and save lives across North-America?

I am indeed thankful to Dr. Hussain Usman, Executive Director, Public Health Surveillance and Infrastructure, Alberta Health Services (AHS) - the first and largest province-wide, fully-integrated health system in Canada, for co-authoring this blogpost with me. An abridged version of this blogpost was published by Tableau Software at < https://tabsoft.co/2saQ0IM > in January 2019.

Context - The Opioid Epidemic in the United States!

The United States is in the throes of an unprecedented opioid epidemic with more than 2 million Americans who have become addicted and abuse prescription pain pills and similar drugs available on the street [1]. The word “opioid” is derived from “opium”.

Opioids are drugs formulated to reduce pain like opium. These include both legal painkillers like morphine, hydrocodone and oxycodone usually prescribed by physicians for acute or chronic pain, as well as illegally produced drugs sold on the street like heroin and illicitly manufactured fentanyl.

Prescription and illegal opioids are abused extensively because they are so addictive. Opioid medications and drugs bind to the pain and emotion controlling areas of the brain, triggering levels of serotonin and dopamine, culminating in a feeling of utter euphoria.

As the brain becomes conditioned to the highs, it takes increased amounts of the drug to generate the same levels of pain relief and euphoria, often leading to dependence and addiction.

"Over 48,000 Americans will die from an opioid overdose in 2019!"

During 2016, there were more than 63,600 overdose deaths in the United States, including 42,249 that involved an opioid (66.4%). That's an average of 115 opioid overdose deaths each day. In 2016, the age-adjusted rate of drug overdose deaths in the United States was more than three times the rate in 1999 [2]. The number of opioid prescriptions dispensed by doctors steadily increased from 112 million prescriptions in 1992 to a peak of 282 million in 2012, according to a recent article in the New York times, and data from IMS Health. The number of prescriptions dispensed has since declined, falling to 236 million in 2016 [3].

Over 48,000 Americans will die from an opioid overdose in 2019, that is already debilitating the quality of life in cities like San Francisco, Wilmington, North Carolina, Pensacola, FL and many other metros across the US and Canada!

Figure 1. The opioid epidemic in the U.S. by the numbers. Source: Centers for Disease Control and Prevention (CDC) and HHS.gov/opioids, December 2017. [2]

"The Centers for Disease Control and Prevention (CDC) estimates that the total "economic burden" of prescription opioid misuse alone in the United States is over $78.5 billion a year!"

The Centers for Disease Control and Prevention (CDC) estimates that the total "economic burden" of prescription opioid misuse alone in the United States is over $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement [2]. While the US has the largest Opioid abuse epidemic amongst developed nations, Canada follows the US in terms of consumption of opioids in doses per million people per day (figure below) [4].

Figure 2. The Top five countries with Opioid abuse 2013-15. This figure illustrates the consumption of opioids in doses per million people per day. Source: International Narcotics Control Board [4]

In this narrative, I will highlight a success story re: addressing this epidemic in Canada, with a case study on how Alberta Health Services (AHS) is leveraging population health data and analytics to pinpoint, then laser focus on the areas in Alberta with opioid abuse, and delivering take home Naloxone kits to friends and family of opioid abusers to help them alleviate them reverse opioid overdose.

Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications [4]. Programs that distribute naloxone to opiate users and their acquaintances have been successfully implemented in a number of cities around the world and have shown that non-medical personnel are able to administer naloxone to reverse opiate overdoses and save lives. [5, 6]

Success Story: Alberta Health Services (AHS) in Canada – proactively detecting and addressing Opioid Abuse

Alberta Health Services (AHS) is Canada’s first and largest provincewide, fully-integrated health system, responsible for delivering health services to the over four million people living in Alberta, as well as to some residents of Saskatchewan, B.C. and the Northwest Territories.

Alberta Health Services (AHS) has over 110,000 employees, including over 102,000 direct AHS employees (excluding Covenant Health staff) and over 8,300 staff working in AHS wholly-owned subsidiaries such as Carewest, CapitalCare Group and Calgary Laboratory Services. AHS is also supported by over 14,300 volunteers and almost 10,300 physicians practicing in Alberta, more than 8,400 of whom are members of the AHS medical staff (physicians, dentists, podiatrists, oral and maxillofacial surgeons). [7]

AHS comprises 106 acute care hospitals, five stand-alone psychiatric facilities, 8,448 acute care beds, 25,653 continuing care beds/spaces and 243 community palliative and hospice beds, 2,723 addiction and mental health beds plus equity partnership in 41 primary care networks. [7]

Programs and services are offered at over 650 facilities throughout the province, including hospitals, clinics, continuing care facilities, cancer centers, mental health facilities and community health sites. [7]

Leveraging Actionable Data Insights at AHS for Opioid Monitoring and Surveillance to save lives across Alberta, Canada

Given the significant opioid abuse epidemic across the state of Alberta, AHS embarked on an ambitious initiative to proactively detect, focus and address the needs of the afflicted by leveraging their self-service visual analytics platform and solutions.

Figure 3. Visual analytics dashboard illustrating the number of Emergency Department (ED) visits and EMS responses to all opioid related incidents by location across Alberta. Source: Alberta Health Services (AHS) [8]

Figure 3 (above) illustrating the number of Emergency Department (ED) visits and EMS responses to all opioid related incidents by location, helps AHS identify the extent of the epidemic and laser focus on the locations with the highest incidence of opioid abuse on a weekly and monthly basis. This is also mapped to the associated ICD-10- CA codes (figure 4 below) to understand the trends in opioid abuse traced to the underlying narcotic and hallucinogen and their relative contribution to the epidemic. This data is further aggregated into an Alberta Opioid Surveillance (AOS) summary executive dashboard (figure 5 below) that enables executives, clinical and operations leaders at AHS to interactively ask and answer their questions pertaining to the epidemic with drill downs into causal analysis as needed.

Figure 4. Opioid related Emergency Department/Urgent Care center visits mapped to ICD-10- CA codes showing trends in opioid usage by the specific narcotic or hallucinogens. Source: Alberta Health Services (AHS) [8]

Figure 5. AHS Opioid Surveillance (AOS) summary executive dashboard that enables executives, clinical and operations leaders at AHS to interactively ask and answer their questions pertaining to the epidemic with drill downs into causal analysis as needed. Source: Alberta Health Services (AHS) [8]

Visual analytics solutions such as these not only help AHS understand trends and the drugs contributing to the opioid epidemic in Alberta, but even more importantly, identify the patient populations most vulnerable to this epidemic by location. This in turn, helps them forecast, allocate and distribute Take Home Naloxone (THN) kits targeting the vulnerable population via pharmacies and walk in clinics in close proximity. Identifying and geo mapping these pharmacies and walk-in clinics on visual analytics dashboards published on the AHS web-pages (figure 6 below) enables these patients, their relatives and their friends to rapidly identify the nearest pharmacy or walk-in clinic with location details and procure the THN kits to help their near and dear ones reverse the effect of an opioid overdose.

Figure 6. Listing and geo mapping pharmacies and walk-in clinics distributing Take Home Naloxone (THN) kits on visual analytics dashboards published on the AHS web-pages. Source: Alberta Health Services (AHS) [8]

Ongoing program monitoring for executives and business leaders is accomplished via executive level dashboards to help them periodically monitor, measure, analyze and improve the program based on these actionable metrics and KPIs. While still early, the opioid monitoring and surveillance initiative at Alberta Health Services (AHS) enabled by actionable self-service visual analytics, and bolstered by the distribution of the Take-Home-Naloxone (THN) kits (over 127,000 THN kits distributed as of September 2018) targeting the most vulnerable and at risk, is promising and has impacted the lives of hundreds of thousands of real-world patients afflicted by opioid addiction.

"The time has come to tackle this epidemic with the tools and platforms of the 21st century including Artificial Intelligence (Machine Learning, NLP) and Analytics."

In Closing.....

The time has come to tackle this epidemic with the tools and platforms of the 21st century, including Analytics integrated with Artificial Intelligence (AI) comprising Machine Learning and Natural Language Processing (NLP). Crafting a national opioid disease registry enabled by self-service analytics and providing visibility to policy makers, healthcare providers and citizens at large, would be a step in the right direction. This would enable states, communities and health organizations with a reliable picture of the extent of the opioid epidemic in their communities, as a first step. Monitoring the number of opioid cases in emergency departments mapped to the associated opioid, based on actionable analytics with AI (machine learning, and NLP) and Analytics, would help these communities laser focus on the most impacted communities and zip codes, and address the challenge head on, as Alberta Health Services (AHS) has demonstrated. Proactively distributing take home overdose reversal kits to patients and their families to restore normal respiration to a person whose breathing has stopped, would go a long way to reduce the large number of fatalities resulting from opioid overdose across the nation, to proactively address what is arguably, "the most menacing epidemic of the 21st century".

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Disclaimer: The perspective and views expressed in this Blog post are my own and do not represent those of my current or previous employers.

REFERENCES:

1.   ‘Opioid Crisis Fast Facts’, CNN, June 16th, 2018. <https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html >

2.   ‘Drug Overdose Deaths in the United States, 1999-2016, Centers for Disease Control and Prevention (CDC), NCHS Data Brief # 294, December 2017. <https://www.cdc.gov/nchs/products/databriefs/db294.htm >

3.   Abby Goognough and Sabrina Tavernise, ‘Opioid prescriptions drop for the first time in two decades’, The New York Times, May 2016. <https://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html>

4.   Owen Amos, ‘Why Opioids are such an American problem’, BBC, October 25th, 2017.   < https://www.bbc.com/news/world-us-canada-41701718 >

5.   National Institute on Drug Abuse, ‘Opioid overdose reversal with Naloxone’, April 2018. <https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio>

6.   National Institutes of Health, US National Library of Medicine, ‘Preventing Opiate Overdose Deaths: Examining Objections to Take-Home-Naloxone (THN), <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008773/>

7.   About Alberta Health Services <https://www.albertahealthservices.ca/about/about.aspx>. Check out their web-pages on Opioid abuse and treatment at <https://www.albertahealthservices.ca/info/Page16025.aspx>

8.   Dr. Hussain Usman, Alberta Health Services (AHS), ‘The opioid crisis, visual analytics, and IT performance reporting at Alberta Health Services’, Presentation at the Tableau Customer Conference (TC-18), New Orleans, October 2018. View the entire presentation on YouTube at < https://www.youtube.com/watch?v=t0-gRCy3NYI&feature=youtu.be >