Combatting the epidemic: How these providers are reducing opioid usage

VA initiative reduced high-dose opioid usage by more than 50 percent

In light of the continuing U.S. opioid epidemic, Marty Stempniak in Hospitals & Health Networks profiles how three hospitals and health systems are rethinking how they treat patients in pain.

VA's Opioid Safety Initiative

The Veterans Health Administration's Opioid Safety Initiative equips patients who presently have high-dose prescriptions with tools to handle their pain in other ways, including via pain coaching and alternative medical treatments, such as acupuncture.

At its initial implementation sites, the initiative reduced high-dose opioid usage by more than 50 percent, without any corresponding increase in pain-scale scores.

Rollin Gallagher, VA's deputy national program director for pain management, said that for such a program to work for hospitals, "there has to be a culture change from the top on down." He added, "If you have a few clinicians trying to do it on the front lines, but the CEO or chief medical officer of the hospital aren't behind it, that's going to be a problem. You have to have everybody on the same team."

St. Joseph's Regional Medical Center's 'opioid-last' ED

In New Jersey, St. Joseph's Regional Medical Center now prescribes opioids as a last resort—only after attempting alternative approaches to pain management, such as nerve blocks and trigger-point injections. And while 25 percent of ED patients still require an opioid prescription, St. Joseph's ED has cut opioid prescriptions by 38 percent since January of this year.

"For physicians, these have been a panacea, an opportunity to really aggressively manage pain without going to the opioids first," said Mark Rosenberg, the hospital's chair of emergency medicine. "The goal of the program was to go to opioids last." And gaining buy-in from physicians was easy, he said, as many shared the desire to reduce opioid use.

Duke University Health System's effort

By contrast, at Duke University Health System, physicians were initially skeptical of its push to reduce opioid prescriptions by adhering more strictly to state guidelines, said Lawrence Greenblatt, an associate professor of community and family medicine at Duke.

How physicians can help curb the opioid epidemic

"In the oncology group, they practically threw tomatoes at me a year and a half ago when I talked to them," he said. But while they were "completely uninterested" at first, provider education from Greenblatt showed oncologists in the system that "just because [patients] have cancer doesn't mean [they're] exempt from having a drug problem."

Duke's chronic pain initiative coordinator Cindy Haynes also has increased buy-in by facilitating physician education. Haynes facilitates a monthly call in which a pain specialist presents three real cases of patients who presented with pain. Doctors call in to analyze each case and develop a treatment plan—good practice for instances when they encounter patients who need similar resources.

"Standard pain management should not be a specialty," Greenblatt said. "It has to be something where we all do our part" (Stempniak, Hospitals & Health Networks, 10/11).

How hospitals can reduce opioid prescriptions—and cut millions in costs

As legislators grapple with the opioid epidemic, hospitals are also rethinking their prescription practices. We polled over 200 acute care pharmacy leaders to understand how they are making formulary decisions, and what's the impact on reducing opioid prescriptions and related complications.

Read the research brief to learn more about our analysis of more than 400 organizations to investigate the impact of multi-modal pain regimens, and how your organization may be able to save over $1 million by reducing opioid use during surgery.

Download the brief

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