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Consider these five opportunities to help curb one of the biggest public health issues of the year.
As 2017 ends, there’s no doubt the opioid crisis will go down in the books as one of the foremost public health issues of the year-if not the decade.
Drug overdoses are now the leading cause of accidental death in the U.S., and patients, emboldened by the media, have been looking for answers. Many experts have pointed to specific events, such as congressional legislation marking a “decade of pain control and research” in 2000; the Veterans Health Administration recognizing pain as a fifth vital sign that same year; and pharmaceutical companies introducing more powerful, longer-acting drugs in response; however, while these efforts to pinpoint causes are critical (those wise words of George Santayana, “those who fail to understand the past are doomed to repeat it,” apply in healthcare as well as anywhere else), it’s now time for actionable solutions.
While the opioid epidemic is a system issue, which will require the cooperation of virtually all segments of businesses, governments, and communities to address, many healthcare leaders are asking themselves what they can do now, in their own organizations, to make an immediate impact.
Though far from a comprehensive list, here are five opportunities may provide a running start.
1. Consider nonpharmacological therapy for chronic pain. More than 100 million Americans suffer from chronic pain (Institute of Medicine), and according to the National Survey on Drug Use and Health, almost as many people (91.8 million or one in three Americans) were prescribed an opioid drug in 2015. That same year, there were more than 20,000 overdose deaths related to prescription pain relievers (American Society of Addiction Medicine). The conclusion here is sobering: When used improperly, prescription pain medications can be deadly-and it’s easy for even the most experienced physicians and well-meaning patients to use them improperly. For many people, the quantity of opioids they need to see an effect will always increase, establishing an unsustainable, and often, dangerous pattern. There are many nonpharmacological options for those who need to manage pain over time. Alternatives to consider include, for example: heat, ice, message therapy, physical therapy, transcutaneous electrical nerve stimulation and aromatherapy. Prescribers should consider these options, carefully weighing their pros and cons against those of their opioid counterparts.
2. Establish realistic pain management goals. Before starting a treatment plan, it’s critical that physicians and their patients establish realistic goals that balance the obvious need for pain relief with other important outcomes, such as general quality of life (which can be significantly impacted by the many side effects of opioids). All parties should understand that, generally, it’s impossible to safely eliminate all pain, and in fact, a perceived pain reduction of 30% is a reasonable “win” in this area. Of course, adopting this perspective is easier said than done-a convergence of factors, including those outlined in the introduction to this article, have resulted in loosening attitudes toward prescribing opioids and a corresponding demand for total pain management – however, as a culture, and starting at an individual hospital level, we must manage our expectations, as for most patients, opioids cannot be a long-term solution.
3. Develop better reporting standards. Arguably, data are the healthcare industry’s number one defense when it comes to preventing unnecessary opioid prescription and, accordingly, misuse and/or dependence. Prescription drug monitoring programs (PDMPs), are being utilized to allow 360-degree accountability by tracking patients’ opioid use as well as the prescribing histories of doctors. When the whole patient care team has access to such a system, individual members are empowered to recognize and intervene at the first sign of problematic behaviors such as patients who are “doctor shopping” or doctors who may be unknowingly unsafe in their prescribing practices. According to the CDC, state-level use of PDMPs have already resulted in improvements in prescribing behaviors, less use of multiple providers by patients, and decreased substance abuse treatment admissions. While health leaders may historically have been conditioned to keep data close to the vest, they should be ready for such industry-wide collaboration, embracing it for the opportunities it presents for both improved patient experience and better health outcomes.
4. Monitor for and adopt new guidelines. In response to the opioid crisis, industry organizations are rapidly developing new guidelines, often with stakeholder feedback, to guide healthcare leaders through an increasingly challenging environment. Healthcare leaders should assign team members in each discipline (nursing, pharmacy, providers, etc.) to monitor for the latest research and recommendations on what healthcare organizations can do to fight the opioid epidemic. For example, the Pharmacy Quality Alliance recently endorsed new performance measures to help physicians identify problem users and reduce their opioid prescription rates, while the CDC recently recommended that extended release or long-acting pain medication only be used for cancer pain. Good ideas may be found in a range of healthcare disciplines, and smart organizations must be committed to sourcing and combining “the best of all worlds” to make sure their organization is acting in accordance with best practices and emerging regulations.
5. Follow up with patients. When a patient is prescribed opioids- especially given the current climate-his or her patient care team has a responsibility to follow up and be sure he or she is continuing to use the medication responsibly. A good rule of thumb is for providers, or even pharmacists (who may have a closer relationship with patients, and be more familiar with their medications) to follow up within one to four weeks of a patient starting long-term therapy or increasing their dose, or more generally, at least every three months.
The opioid epidemic is a nationwide issue, touching, however indirectly, almost every individual and community in the U.S. While over the next many years, decisions must be made at the highest levels to combat the opioid crisis, healthcare leaders must remain vigilant in spotting unintended consequences as these issues were-in part-driven by well-meaning policy. In the meantime, individual healthcare leaders can and should continue to consider ways, such as the tactics listed above, they can contribute in the interim to benefit their patients, their business, and their country.
Kenneth Maxik is the director of patient safety and pharmacy compliance for CompleteRx.