Every day, more than 130 people in the United States die after overdosing on opioids¹. The misuse of and addiction to opioids – including prescription pain relievers, heroin and synthetic opioids, such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention (CDC) estimates that the total ‘economic burden’ of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement².
The complexity and severity of this crisis requires coordinated approaches at the local, regional and state levels, because the solutions involve diverse sectors within communities. Healthcare providers have an important role to help reverse the exponential growth in opioid-related morbidity and mortality.
Recently, an Omaha World Herald article drew attention to Nebraska healthcare providers employing a variety of approaches to reduce the use of opioids when possible and the data shows the commitment is paying off. As a result of this ‘all hands-on deck’ approach to addressing the epidemic, Nebraska has reduced opioid prescriptions by 32 percent.
Local health systems are taking a variety of approaches in their efforts to cut back, including reducing the use of opioids before, during and after surgery, and revising and standardizing orders for pain medications. They are also emphasizing alternatives such as non-opioids and comfort measures, including icing and music therapy for pain relief and offering pain education. Also, the use of local and regional anesthesia is expanding.
Several Nebraska hospitals and health systems were featured and shared approaches and data to support their efforts, including:
- CHI Health has reduced or eliminated opioids from a number of surgical procedures. Although numbers vary from procedure to procedure, one official estimated that Creighton University Medical Center-Bergan Mercy has reduced the drugs for all surgeries by 50% or more.
- Methodist Health System scaled back total prescribing across the organization, including inpatient and outpatient, by 750,000 pills from 2017 to 2018, a reduction of 12%. The bulk of reductions have come through its outpatient clinics.
- At Nebraska Medicine, the number of opioid medication orders per 1,000 patient days decreased by 35% between July 1, 2016, and March 31.
- Faith Regional Health Services in Norfolk tallied reductions in inpatient opioid use of about a third from December through February after launching a new acute pain assessment and management strategy. It de-emphasizes the 1 to 10 pain score patients are familiar with and adds objective signs of pain, such as heart and respiratory rates. Read more.
Another contributing factor is the use of Nebraska’s Prescription Drug Monitoring Program (PDMP). Since Jan. 1, 2018, all prescriptions dispensed to Nebraskans must be entered into the state’s monitoring program. From January to May 2019, Nebraska providers made more than 240,000 queries, more than double the number during the same period in 2018.
A change to Nebraska law that went into effect last month will allow health systems and pharmacies to embed the prescription drug monitoring program directly into their electronic medical record systems. It will also allow Nebraska to exchange data with other states.
Read more about Nebraska’s Prescription Drug Monitoring Program.
“Everyone in healthcare is working with patients and families to reduce the use of opioids through education and offering alternatives for pain management. The Nebraska PDMP is a tool available for providers, pharmacists and clinicians to query opioid prescriptions.” stated Paula Sitzman, RN, BSN, Quality Improvement Advisor with Great Plains Quality Innovation Network.
The Great Plains QIN continues to partner with providers, pharmacists and stakeholders in our region to reduce misuse and overuse of opioids. Tools and resources for providers can be found on the medication safety web page.
Sources:
- National Institute on Drug Abuse; Opioid Overdose Crisis
- National Institute on Drug Abuse; Opioid Overdose Crisis
- Omaha World Herald, Live Well Nebraska, Omaha-area health systems make progress in reducing opioid prescribing