Opinion: Hospital formularies can play key role in reducing opioid epidemic

December 21, 2016

Adding non-opioid postsurgical options to hospital formularies should be a top consideration.

The opioid epidemic has become rampant in the United States this past year and has proven it can affect anyone despite their race, income level, age or gender-as evidenced by the frequent headlines surrounding addiction, dependence and abuse. According to the Centers for Disease Control and Prevention, 78 people die every day in the U.S. from an opioid induced overdose.

GanFor many patients, addiction or dependence begins when their doctor prescribes an opioid following surgery. In fact, a recent survey of 500 U.S. adults by Wakefield Research, with support from Pacira Pharmaceuticals Inc., found that one-in-10 postsurgical patients prescribed an opioid report becoming addicted to or dependent on the drug. With an estimated 70 million surgery patients in the U.S. receiving an opioid annually, as many as 7 million patients could develop an opioid addiction or dependency this year.

With these startling statistics, opioid dependency is not something we can afford (literally) as there are many financial implications. In fact, a recent study in Medical Care found that the estimated total financial burden of the opioid epidemic is $78.5 billion for Americans.

When looking at hospital economics specifically, data published in the Journal of Pain andPalliative Care Pharmacotherapy found that patients experiencing opioid-related adverse events led to a $4,707 increase in hospital costs, a 3.3 day increase in length of hospital stay and an overall 30-day readmission rate.

One way to address the problem

As hospitals continue to evaluate and evolve strategies for patient care and satisfaction, it’s crucial that the medications on formulary become a priority. For example, there are effective, non-opioid options available that administrators should consider based on their safety, efficacy and cost-effectiveness. Multimodal therapy-which manages pain using a mixture of non-opioid options such as local and/or regional anesthesia, anti-inflammatories, and acetaminophen-is a pain management strategy that hospitals should implement.

This approach can result in shorter inpatient stays and recovery periods, as well as decreased exposure to opioids. Multimodal strategies can also result in significantly lower costs-for both hospitals and patients-over the long-term. Overall, providing patients non-opioid options can help significantly reduce the need for opioids and potentially increase patient satisfaction.

Having non-opioid options on formulary can help hospitals differentiate themselves from other institutions, while empowering surgeons to provide patients with pain management alternatives. This business decision would resonate with patients as nearly 80% would prefer a non-opioid pain management option, according to the Choices Matter Survey. The same national survey found that less than a quarter of patients have discussed non-opioid options with their clinicians prior to surgery, demonstrating the need to foster dialogues between patients and their medical team.

Although patients have access to resources such as PlanAgainstPain.com, which has a customizable guide to facilitate a surgeon-patient discussion, their efforts to prepare for these critical conversations will not be beneficial if their preferred hospital doesn’t offer non-opioid alternatives. With heightened awareness around the opioid epidemic, hospitals should have a commanding presence in mitigating the societal burden of opioid use and addiction by offering these desired options.

Surgery has become an unintentional gateway to the opioid epidemic, but this epidemic can be won if there is a collaborative effort from healthcare executives, hospital administrators, pharmacists, surgeons and patients to have an open dialogue about opioid sparing strategies.

Breaking out of tradition and habit-such as the norm to prescribe opioids-can be a difficult transition. However, hospitals can do their part by ensuring alternatives are available to help patients manage their postsurgical pain, including non-opioid options. This strategy will enable hospitals, and surgeons, to truly revolutionize patient care.

T.J. Gan, MD, is president of the American Society for Enhanced Recovery and chairman of the department of anesthesiology at Stony Brook University.