The opioid epidemic exploded in 2020 due to the COVID-19 pandemic, which caused isolation and unemployment as a result of the economic downturn.
In 2020, there were over 92,000 opioid overdose deaths in the U.S. compared to 71,000 in 2019, according to Jerry Storm, senior vice president of Pharmacy Services for OSF HealthCare.
But even before the pandemic and those startling statistics, OSF HealthCare was making strides to help address the opioid crisis by reducing the amount of opioids prescribed and getting treatment strategies in place.
What is OSF HealthCare doing?
“We are continually educating providers about the dangers of opioids and how it’s important to not use opioids as the primary drug to relieve mild to moderate pain,” Jerry said. “When opioids must be used, our guidance is to try to limit the use for only 48-72 hours for severe acute pain and then transition to a non-opioid pain reliever.”
To achieve this, OSF aligned the default number of tablets or capsules prescribed within its electronic medical record (EMR) system to the Illinois Surgical Quality Improvement Collaborative recommendations based on procedure.
“This allows our providers to appropriately prescribe quantities to match the type of procedure being performed,” Jerry said.
OSF has taken other steps as well by establishing non-opioid prescription orders in the EMR as an alternative to opioids for treatment of mild to moderate pain. For those patients where opioids have to be used to treat chronic pain, a pain contract is established that details expectations of the patient and the consequences if the patient breaks the contract.
“We’ve seen encouraging results in the number of opioid tablets allowed per prescription (down 6%), the overall number of opioid prescriptions (down 13%) and in the total number of opioid tablets prescribed (down 26%),” Jerry said.
Guidelines to follow
OSF follows opioid prescription for chronic pain management guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). The purpose of the guidelines is to improve the communication between a provider and their patient around the risk and benefits of opioid therapy for chronic pain. The goal is to improve the safety and effectiveness of pain treatment and reduce the risks associated with long-term opioid therapy.
Jerry points out that the guidelines exclude managing the pain associated with cancer, end-of-life care or during palliative care. The guidelines use a four-step approach to address assessment, plan development, medications and available adjunct therapies.
During assessment, it’s necessary for the provider to review whether a patient’s pain is chronic (more than three months or past the time of normal healing) or acute (less than three months or consistent with normal healing).
Other factors assessed include the pain’s location, timing, origin and the impact it has on the patient’s normal function. In addition, behavioral health conditions taken into consideration include depression, anxiety, post-traumatic stress disorder, sleep disorders, substance abuse and a decline in normal activity.
Care plan development
Multiple things are considered by the provider during this step. They include:
- Explaining that opioids are not routine therapy for chronic pain
- Establishing and measuring goals for pain and function
- Providing treatment based on the source of pain
- Discussing the benefits, risks and availability of non-opioid treatment – such as medication and other therapies, such as care management by an OSF pain clinic, physical rehabilitation or medical exercise
- Following up at regular intervals
At this point, it’s important the patient express any concerns if they are prescribed an opioid.
“A patient has the right to ask if they need an opioid for pain control or if there’s another option such as taking acetaminophen (Tylenol) or a non-steroidal option (ibuprofen/Motrin) for adequate pain control,” Jerry said. “They can also ask about other therapies, such as if they can use heat or cold to help with pain control in combination with a non-opioid analgesic or would physical therapy provide them pain relief.
“You are your best advocate. An individual should not hesitate to speak up if they feel strongly that an opioid is not the care path they want to experience,” he said.
Alternative medications and therapies
In addition to acetaminophen and ibuprofen, other alternative medications a provider will consider are muscle relaxants, various medications for neuropathic pain, topical agents and disease-modifying medications.
To manage their pain, a patient may also be referred to other therapies offered by OSF, such as pain clinic, medical exercising or conditioning, ambulatory nutrition, rehabilitation, sleep clinic, behavioral health and smoking cessation.
“Patients wanting an alternative to opioids should discuss with their provider other first-line medication options and adjunct therapies,” Jerry said. “It’s important to express your desire to avoid or minimize the use of opioids for pain relief.”
As OSF continues to focus on diminishing the reliance on opioid prescriptions, Jerry said continued education of providers and patients about the dangers of opioids ranks high on the list.
“We also are looking at initiating medication-assisted treatment programs for patients with an opioid use disorder,” he said.
Dispose of medications properly
There will also be more awareness around the increased need to prescribe naloxone (Narcan) for opioid-naïve patients and those prescribed a daily dose of 50 morphine milligram equivalents or more.
If someone has to take an opioid, Jerry offers the following tips to do so safely and to keep their family safe:
- Always store medications away from children.
- Never share your medication with others.
- Take the opioid at the lowest dose and shortest period of time that provides adequate pain relief.
- Take the opioid for only 48-72 hours if possible and transition to a non-opioid analgesic.
- Dispose of all unused medications as soon as possible.
Signs of misuse or abuse
If you suspect someone of misusing or abusing an opioid, Jerry urges you to call the Substance Abuse and Mental Health Services Administration (SAMHSA) at (800) 662-4357, which can provide resources for the individual and their family.
Some signs of misuse or abuse include:
- The inability to control opioid use
- Uncontrollable cravings
- Drowsiness or inability to stay awake, changes in sleep habits
- Weight loss
- Frequent flu-like symptoms
- Decreased libido
- Lack of hygiene
- Changes in exercise habits
- Isolation from family or friends
- Stealing from family, friends or businesses
- New financial difficulties
- Slurred speech
- Irritable or argumentative
Proper disposal of opioids and medications
“It’s important to properly dispose of opioids and all medications to prevent accidental poisonings or overdoses of children, elderly and pets,” Jerry said. “Proper disposal eliminates the temptation for teenagers to experiment with taking opioids. And to prevent drugs from entering into our rivers, streams and drinking water, do not place drugs down the drain or toilet to dispose of them.”
To properly dispose of drugs, be aware of the bi-annual Drug Enforcement Agency drug take back program held in your area. You can also dispose of medications at an OSF drug disposal box, some retail pharmacies, such as Walgreens and CVS, and local law enforcement departments.