With addiction to opioids and other pain-relieving medications reaching record levels in the United States, at 2 million in 2015—according to the American Society of Addiction Medicine, it’s important for providers to employ strategies to avert dependence. From 1999 to 2015, more than 183,000 people died in the United States from overdoses related to prescription opioids, the CDC reported. Here’s a look at what healthcare providers are doing to decrease dependence.
1. Pick a pain management quarterback
With the burden of coordination for pain care management following inpatient procedures such as orthopedic surgery typically falling on the surgeon, it’s important to carefully coordinate a patient’s narcotic prescriptions with the primary care physician, says Greg Sullivan, MD, who is board-certified in internal medicine and addiction medicine. “Prescription monitoring of every patient for six months after discharge is particularly important, in that post-discharge, patients are often seen for follow-up by multiple providers, with overlapping prescriptions for narcotics quite common,” he says. “It’s best to pick a single physician source for pain medication, and particularly effective to allow the provider that is also formulating rehabilitation plans to provide that pain medication.”
2. Have an exit strategy
Patients who take opiates for two months have a marked increase risk of continuing those opiates chronically, says Sullivan, who is also a clinical investigator focused on safer alternatives to full-agonist opioids, and is chief scientific officer of pharma start-up Bridge Therapeutics. “These patients find it difficult to wean from those medications after an illness or surgical episode has resolved, and they are unable to get off the medications because of withdrawal or other dependence issues. Providers should have a definite exit strategy that involves weaning patients off of pain medications to less addicting agents early on, to help with the process of returning the patient to a normal livelihood without the need for chronic opiates.”
3. Analyze data
To prevent opioid misuse in both chronic and acute care patients, Allina Health, a large healthcare system based in Minneapolis, Minnesota, evaluated how it managed acute noncancer pain in the outpatient setting, particularly among opioid-naïve patients.
Nicole M. Kveton, RN, MHA, vice president, quality, value, and nursing at Allina Health Group, says data analysts used the Health Catalyst Analytics Platform and Data Warehouse to obtain data on prescribing patterns for the acute pain committee to review, including data for specific medications, differences in prescribing patterns between and among specialties, and data on each provider’s prescribing practices.
Following the data review, the committee identified opportunities to reduce the number of patients prescribed more than 20 pills in one prescription for acute pain. “This would lower the risk of long-term use or abuse and reduce the potential for opioids being diverted into the community,” Kveton says. “The committee then developed a comprehensive guideline for the appropriate use of opioids in patients with acute pain, and has plans to develop a chronic pain guideline as well.” All providers were required to complete a newly developed education program.