Utah-based Intermountain Healthcare set a bold goal last year in its efforts to curb opioid abuse: Reduce prescriptions for the pain relievers by 40% by the end of 2018.
Now, eight months into the project they started in August, the system has already cut prescription rates 20% by working to get both physicians and patients behind the effort.
Intermountain asked doctors to focus three main areas: cutting down on acute opioid prescriptions, reducing how frequently opiates are prescribed alongside benzodiazepines, and offering medication-assisted recovery treatments, David Hasleton, M.D., associate chief medical officer at the health system told FierceHealthcare in an interview.
At the same time, they sought to educate patients about the effort. When patients understand the risks, they can make informed decisions alongside their doctors to ensure they're getting the best—and safest—care, Hasleton said.
These projects are becoming more important as the opioid epidemic shows no signs of slowing down. The Centers for Disease Control and Prevention found that more than 42,000 people died of an opioid overdose in 2016, an increase of more than 27% from 2015.
The Substance Abuse and Mental Health Services Administration estimates that 11.8 million people misused opioids in 2016, and a report from the White House found that the epidemic cost $504 billion in 2015 alone.
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Cutting back on opioid prescriptions is a key element to addressing the opioid epidemic, and many providers are stepping up to the plate. In Colorado, for example, a pilot program that focused on pain management in the emergency department led to a 36% reduction in six months—far surpassing the project's goal of a 15% cut.
Getting doctors at Intermountain's 22 hospitals on board was the biggest challenge and offered the most significant lesson, Hasleton said. Intermountain initially intended to be "prescriptive" in its approach. But leaders learned physicians may chafe under strict opioid reduction programs as they can be difficult to balance with the legitimate needs pf pain patients.
Instead, the system learned that educating and involving physicians leads them to "self-correct." Intermountain launched a dashboard that compares its physicians' opioid prescribing habits with their peers, and is broken down by specialty. Hasleton said that the more doctors are exposed to prescribing data like this, the more likely they are to buy-in to a program that reduces opioid use.
"Physicians are initially skeptical; they deny it," he said. But the system has examined its data so many times and through so many lenses that "we really feel it's accurate—and now they're accepting it."
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The health system also launched several other initiatives aimed at the opioid epidemic, Hasleton said. It has placed prescription drop boxes in pharmacies to encourage patients to turn in unused painkiller pills that might otherwise be diverted. So far, more than 13,000 pounds of medications have been turned in.
The system has also made it easier for patients and families to access naloxone, a medication designed to rapidly reverse opioid overdose, at the pharmacy, Hasleton said.
Other hospitals and health systems that are looking to cut back on their opioid prescription rates can take similar steps, but it's crucial to start with a strong understanding of internal culture and unique challenges faced by their patient populations, he said.