7 Must Reads for Battling the Opioid Epidemic

The PPAHS team has been reading many must read articles for battling the opioid epidemic this week.

Must Read Articles for Clinicians and Hospital Executives for Battling the Opioid Epidemic

The recent article in Managed Healthcare Executive, “Four risks healthcare executives should monitor in 2018” not surprisingly reminds us that the “opioid crisis isn’t going away”:

“Given the link between overdoses and legally prescribed opioids, providers face growing scrutiny over their prescription behavior, especially sub-standard practices like failing to consider alternative treatments or obtaining informed consent. If a patient is harmed or injured, providers can potentially face both professional and criminal liability.

“With no community left untouched by the crisis, every healthcare organization should develop an opioid prescription risk management plan for 2018. This six-part plan is an effective approach to curbing exposure and should begin with designating a clinical leader responsible for the oversight of pain management and safe opioid prescribing across the organization.”

This article, “Eight ways doctors can address the opioid epidemic” discusses eight steps that doctors can take:

  1. Pick a pain management quarterback – “carefully coordinate a patient’s narcotic prescriptions with the primary care physician.”
  2. Have an exit strategy – “Providers should have a definite exit strategy that involves weaning patients off of pain medications to less addicting agents early on, to help with the process of returning the patient to a normal livelihood without the need for chronic opiates.”
  3. Analyze data – Allina Health Group used to data to identify “opportunities to reduce the number of patients prescribed more than 20 pills in one prescription for acute pain.”
  4. Tweak your EHR – “To support providers in following the new guidelines, Allina revised its electronic health record system, developing a structured order set and progress note to aid in adherence to the chronic pain management guideline.”
  5. Discuss alternatives with patients – “Providers and care team members need to have conversations with their patients, setting clear expectations and encouraging shared decision making on the best approach for managing pain.”
  6. Pinpoint the pain source – “the best way to treat chronic pain is to properly identify the source.”
  7. Provide chiropractic care – At Myrtle Hilliard Davis Comprehensive Health Centers in St. Louis, Missouri, “The medical doctors at this facility can refer patients in-house for a trial of conservative care before resorting to prescribing opioids.”
  8. Use available tools – “In an effort to battle the epidemic, the Accreditation Association for Ambulatory Health Care developed and released an opioid stewardship toolkit derived from CDC guidelines.”
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Must Read Articles for Battling the Opioid Epidemic and Keeping Patients Safe

However, three studies indicate that caution should be exercised before prescribing an opioid:

  • In the emergency room – in research conducted among emergency room patients “opioids don’t do much more for pain than ibuprofen or acetaminophe”
  • With Ob-GYN patients – Clinicians are reminded to assess their patients, prescribe appropriately, and counsel their patients. In recent research cited in the article, “Opioid Prescribing Practices Among OB-GYNs,” only 19% of surveyed OB-Gyns followed three of more of the four recommended practices:
  1. screen for dependence,
  2. prescribe the smallest amount required,
  3. tailor prescriptions, and
  4. counsel on proper disposal.
  • With pediatric patients after surgery – “Because persistent opioid use was more prevalent among teens and young adults who had operations than among those who had not, the researchers suspect that surgery may represent a pathway to prescription opioid abuse.”
  • With smokers who quit smoking – “Evidence suggests that surgical patients who previously smoked but quit are prone to lower preoperative pain tolerance and higher postoperative opioid consumption relative to patients who never picked up the habit.”

Perhaps the best advice in our must read articles this week perhaps comes from Nashville-Based hospital who are warning their patients, “You Will Feel Pain” – “We will treat the pain, but you should expect that you’re going to have some pain. And you should also understand that taking a narcotic so that you have no pain really puts you at risk of becoming addicted to that narcotic,” says Mike Schlosser, chief medical officer for HCA’s national group of hospitals.

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