Fighting a global opioid epidemic through digital surveillance
Finding purpose from a place of pain, Kim Ledger is determined to help save lives. Eleven years after his son, Heath, died in a New York apartment from an accidental prescription drug overdose, Ledger is raising awareness of a global epidemic.
“I guess I became aware of the problem when my son was able to pick up prescriptions in three different countries over a period of four days to try and combat a pneumonia infection that he was trying to fight off,” Kim Ledger told Healthcare IT News sister publication HIMSS Insights.
“And then it was obviously a mixture of one or two of those, together with sleeping tablets, that caused him to sleep permanently, which was heartbreaking.”
There is no doubt that at the time of Heath’s death at the age of 28, he was one of the most celebrated movie stars on earth. Brokeback Mountain, A Knight’s Tale, Monster’s Ball and his performance as the Joker in The Dark Knight – for which he posthumously won an Oscar for Best Supporting Actor – had cemented his reputation as a bona fide acting talent.
But he was also a beloved child, father and brother. And in some ways his family has paid a devastating price for his celebrity.
Kim was at home in Perth, Western Australia, when he turned on the television on a morning in January 2008 to see his son’s body being removed from an apartment building on the other side of the world. That was how he heard the news.
According to the toxicology report, Heath had died from an accidental overdose of prescription drugs including oxycodone, hydrocodone, diazepam, temazepam and doxylamine.
His father says Heath had been easily able to source medications in the UK, Canada and the U.S.
“What surprised me was the ease with which somebody can get hold of the drugs. I mean, in the case of Heath, who had a little more profile than us, it was probably a lay down misère that he would get what he liked. He arrives [at the doctor’s office] and he’s got chest pains: ‘Look I’ve got pneumonia, I need something,’ and basically whatever he wants, he gets.”
But Kim also realized there was a growing international crisis of prescription drug related deaths that was affecting people from all walks of life.
“Just in Australia, we lose three or four jumbo plane-loads of people a year from it and I’d really had no idea as to the scale of the problem.”
In the US, more than 130 people die from opioid overdoses every day.
Now Kim is the founding patron of ScriptWise, a charity that is highlighting the dangers of medication misuse, promoting consumer-centered education for health professionals and engaging with policy-makers. It is also campaigning for real-time digital prescription monitoring. “It’s not a one-stop fix for the problem, for the doctor shopping problem around the world, but I believe that this will go a long way towards reducing some harm in the community.”
Digital prescription monitoring will only work with digital prescriptions. These are becoming more common, with a long way still to go. But efforts are underway. Scandinavian countries have more or less completely switched to digital prescriptions, creating healthy transparency that could be used to counter doctor and prescription shopping.
The US’s Office of the National Coordinator for Health Information Technology’s Health IT Playbook is attempting to tackle the opioid epidemic by promoting the integration of state-based prescription drug monitoring programs with electronic medical records. It is also working with the increased use of ePrescribing for controlled substances and clinical decision support tools, as well as improved access to addiction treatment services via telehealth. Smartphone apps are seen as a way to provide clinicians with treatment options beyond the over-prescribing of medicine.
Some very early efforts are also underway to integrate prescription systems across national borders. Heath Ledger, after all, sourced his medication in different countries.
In Europe, since January 2019, over 1,000 Finnish patients have been able to get medicines at pharmacies in Estonia that were digitally prescribed by doctors in Finland. More countries in the US are poised to connect into the ePrescription and eDispensation systems supported by the European Commission. But it will take many years before these projects will be advanced enough to include cross-border-prescription monitoring. Still, it is a positive first step.
In the meantime, startups are harnessing technologies to help, including through the use of artificial intelligence to predict the likelihood of patients relapsing and smart medication boxes that only release prescribed doses.
For Kim Ledger, who has met with many other grieving families, working towards solutions to the problem is imperative. And the double-edged sword of his son’s celebrity provides him with an opportunity to speak.
“The intensity and the pain and the suffering you feel when you lose a loved one, and particularly a child, as thousands of people across Australia know, is something that doesn’t go away,” he says.
“I’m not out to make some sort of political stand on it or make too much noise about it, but if I’m just there and I’ve become a little bit of a reference point and represent thousands of affected families that have lost loved ones and have suffered all the knock on effects of that too, then I’ve done my job.
“I’ve lost my only son but it’s rewarding to think that over a number of years, with whatever we put in place, we may have just somehow saved somebody else’s life. And I think that’s the important ingredient to me. That’s what drives me.”