America's opioid epidemic hasn't been fueled by illegal street drugs. Sadly, one major contributor that has led patients to drug dependence has been doctor-issued prescriptions after a medical procedure or in response to chronic pain. Since prescriptions can't be written without a physician, it's clear that multi-faceted solutions to address opioid dependence must include the medical community.
Are Prescription Drug Monitoring Programs the Answer?
The Centers for Disease Control and Prevention (CDC) reports that between 2006 and 2017, the annual prescribing rate for opioids decreased 19%. However, the number of opioid prescriptions still remains high. The CDC found that in 2017, there were close to 58 opioid prescriptions written for every 100 Americans and more than 17% of Americans had at least one opioid prescription filled.
Prescription monitoring tools are one option for physicians. However, these may not be as effective as data and analytics that offer insights into patient-specific characteristics. Many states have implemented prescription drug monitoring programs (PDMPs) with the goal of identifying suspicious opioid prescribing patterns.
However, a recent article in Harvard Business Review highlighted the shortcomings in these initiatives. Most PDMPs aren't well integrated with EMRs, so it's difficult for physicians to access information as part of their daily workflows. In addition, most states don't require physicians to check the PDMP before writing an opioid prescription. Even if these checks were in place, most opioid prescriptions don't meet criteria that would flag them as problematic in an PDMP.
The Benefits of Physician Education and Patient-Specific Information
If prescription monitoring tools aren't useful, then what else can physicians do to address the opioid epidemic? It appears that physician education and patient-specific information may deliver a "bigger bang for the buck."
The New England Journal of Medicine, for example, recently launched a free education tool called the Knowledge + Pain Management and Opioids module. This includes over 60 case-based questions focused on issues like pain management, safer prescribing, recognition of opioid use disorders, and treatment of these disorders.
Patient-specific information that is easily accessible as part of routine physician workflows is also key for identifying patients who may be predisposed to opioid dependence. Applying data analytics to patient history can uncover risks related to social, behavioral, or medical factors. The Mayo Clinic has identified several factors that increase the risk of opioid misuse including:
- Demographic factors. Younger individuals are more prone to misuse and addiction. Other contributing demographic factors include poverty, unemployment, and stressful circumstances.
- Behavioral and mental health-related factors. People with a history of severe depression or anxiety may be at greater risk of opioid misuse. Other individuals at risk include those with mental disorders that contributed to problems with past employers, family members, or friends. People who engage in risk-taking or thrill-seeking behavior may also be prone to opioid misuse.
- Problems with other addictions. Individuals with a personal history or family history of substance abuse are more likely to have problems with opioid misuse. Clinicians should be on the lookout for patients with prior drug or alcohol rehabilitation, as well as individuals who are regularly in contact with high-risk people or high-risk environments.
Care management systems and population health solutions are one way to integrate this type of patient intelligence into physician workflows. With relevant data and analytics at their fingertips, it's easier for physicians to quickly identify patients who may be considered “high-risk”” candidates for an opioid prescription. Clinicians are then empowered to find alternative approaches to pain management and also to start a conversation with the patient about opioids. One-on-one conversations can help direct patients to treatment programs, if dependence is an issue for them.
As the medical community, policy makers, and public health professionals struggle to get America's opioid epidemic under control, it seems that one promising approach is to combine physician education with patient-specific analytics. Broader awareness about opioid use disorders and pain management best practices is an essential foundation for the clinical community. Applying that knowledge at the patient level, however, requires data and intelligence about individuals. Technological solutions can lower the barriers to better prescribing practices by weaving those analytics and patient-specific insights into the day-to-day routines of clinicians.
By leveraging the power of patient-level analytics in "rising-risk" populations, it’s possible to address opioid abuse early, before misuse and addiction occur. To learn more about how population health intelligence solutions can help, download HMS's white paper "Stopping the Human Tragedy of Opioid Abuse.”