Developing an Opioid Abuse Program: Three Guidelines from Model Practices

Using our Davies Award recipients as case studies, it’s apparent that changing prescribing practices based on state mandated prescription drug monitoring programs (PDMP), is only the first step to combating opioid addiction. Healthcare providers need to develop comprehensive opioid abuse programs to battle the opioid crisis.

There are several critical areas of focus a health system should consider when structuring a comprehensive opioid abuse program:

1. Ensure patients who have never been exposed to opioids, especially those who have high risk factors for addiction, are not unnecessarily prescribed opioids.
2. Reduce inappropriate prescribing of opioids outside of legal and best practice guidelines.
3. Identify patients who are addicts during an encounter for any health issue and drive those patients to rehabilitative services.

Avoid Unnecessary Exposure to Opioids

First, health systems developing an opioid abuse program should structure best practice guidelines and alerts to ensure that patients are not unnecessarily exposed to opioids. Identifying patients who are at risk for addiction, such as patients who have previously been prescribed benzodiazepine (drugs designed to treat anxiety and a variety of other behavioral health diagnoses), and driving providers through clinical pathways to alternative pain management interventions.

Davies Award recipient Ochsner Health identified critical data needed to identify a patient’s risk of opioid addiction as part of their opioid abuse program. Those data elements populated a unique risk calculator tool which identified patients at a high risk of addiction and drove them to alternative therapies. Ochsner leveraged this decision support to direct patients into innovative approaches to pain treatment, like their back pain program where patients reported a 62% decrease in pain without being exposed to opioids.

Identifying alternative pain treatment options is another method for reducing opioid exposure. Duke Health, a Davies recipient, leveraged clinical decision support and standard orders which allowed recovery room nurses to utilize localized anesthetic instead of prescribing opioids immediately following surgery. Duke saw significantly improved patient outcomes following colorectal surgery using this workflow, while also exposing fewer patients to opioids.

Watch James Hellewell, MD, talk with HIMSS TV about how looking at data, prescribing habits and EHR defaults can help curtail the opioid crisis.

Implement Opioid Prescription Best Practices

While PDMP monitoring is mandated in many states, several Davies recipients built clinical decision support systems populated by PDMP data (along with internal prescribing data) and analytics into their opioid abuse program. With this data, they identify patients demonstrating addictive behaviors and physicians prescribing outside the organization’s model practice guidance.

Davies recipient Mercy Health built decision support systems including associated diagnosis requirements for prescribing opioids, visual indicators of the calculated morphine equivalent daily dose (or MEDD) within the order, and alerts indicating if a patient has been prescribed opioids by multiple providers within a set period of time. With multiple validation points, providers can prescribe appropriately.

The goal isn’t to zero out opioid prescriptions, as that can have the unintended consequence of driving addicts to even more dangerous substances like heroin. The goal is to ensure that every prescription is closely scrutinized to meet the appropriate usage criteria determined by each state and the health system.

Develop Intervention Protocols

When patients demonstrate addictive behavior or are hospitalized as result of an overdose, hospitals have started to create intervention teams as part of their opioid abuse program. These teams work to get the patient access to interventions designed to help them beat addiction.

Another Davies recipient, Rush University Health System, built screening and assessment tools for risk of opioid abuse and addiction for all emergency department admissions into their EHR workflow. At-risk patients trigger an automatic order to initiate action by the their substance abuse intervention team (SUIT). This team-based consultation service consists of physicians trained in addiction medicine, advanced practice nurses, registered nurses, licensed social workers and pharmacists working together to identify and treat patients at risk for opioids and other substances.

One of the key factors of success for an opioid abuse program was programing measurement of patients who go to rehab and those who complete the program into the organization’s quality measurement assessments.

Several other Davies recipients had similar response teams who intervened through direct patient encounters and had the responsibility of follow up to ensure those patients receive rehabilitation services.

Of these three key approaches to battling the opioid epidemic, the approach of screening all patients and then developing care coordination to get at-risk patients the help they need seems to have gained the least traction across the industry.

It’s not hard to see why. The process of screening requires a significant investment of time and resources. The additional documentation needed to calculate risk can be disruptive even with the best information and technology tools. And the resources required to coordinate care and track the patient through the recovery process, or engage the patient if they are resistant to seeking recovery, are substantial.

However, organizations making this commitment within their opioid abuse program have seen significant impacts, ranging from reductions in the number of prescriptions of opioids within their system and significant reductions in overdoses and overdose deaths within their community.

Originally published June 10, 2019