It’s hard to find good news in the press these days. Between the coronavirus pandemic, the charged election environment, and wildfires across California, it seems like every time we scroll through our media feeds all we see is problems.
Add to that the fact that the coronavirus pandemic has exacerbated the preexisting opioid pandemic, and we see yet another problem. It’s been particularly disheartening for professionals working in addiction and recovery to learn that the small amount of progress we made between 2017 and 2019 addressing the opioid crisis is in danger of being eclipsed by the secondary effects of the coronavirus pandemic. Namely, the fact that stress, isolation, reduced access to treatment, and uncertainty all increase chances of increased opioid use or relapse to opioid use.
However, in the midst of all this, a report from Texas shows that one program made a difference in a key metric known to be one of the root causes of the opioid epidemic: the over-prescribing of opioids to manage post-operative pain after elective surgeries.
The Initiative: Educate Physicians to Reduce Opioid Prescriptions
Data from the CDC show that receiving a prescription for opioids that lasts longer than five days creates risk for opioid misuse and opioid use disorder (OUD). This data connects the initiation of opioid use to pain management after short-term elective surgeries. It indicates that long-term opioid use is often the result of dependence that develops unintentionally while in recovery from surgery. We note that in some cases, opioids are effective in the management of long-term, chronic pain – and we reiterate the CDC guidelines that dictate that any decision about pain management should be made between the prescribing physician and the patient, rather than based on an arbitrary set of rules applied in a one-size-fits-all manner.
With that said, the data clearly suggest that a contributing factor to the opioid crisis was the over-prescribing of opioid pain relievers to manage pain that could have been managed with a short course of opioids followed by different pain relievers that carry little to no risk of addiction or disorder use.
This knowledge led to a large-scale effort by Baylor Scott & White Hospitals (BSW) in central Texas to reduce opioid over-prescribing in their clinical network. The BSW includes 15 hospitals, 104 hospitals, and over 1500 physicians. The initiative involved taking advantage of surgical grand rounds to inform physicians about the connection between opioid prescribing practices and the risk of opioid use disorder, and to establish a standard of limiting opioid prescriptions to five days or less after elective surgery. After the educational workshops, the hospital system used its electronic records system to monitor and reward physicians for reducing the number of opioid prescriptions.
The Results: Dramatic Reduction in Long-Term Prescriptions
The initiative and the study on the initiative lasted from January 2018 to March 2019. They involved over 30,000 patients who underwent elective surgery in the BSW hospital and clinic network. Here are the results of the effort, as reported in the study:
- Prescriptions for opioids lasting longer than five days dropped from 1,228 in the three months prior to the program to 432 in the first quarter of 2019.
- That’s a decrease of 64%
- Prescriptions lasting less than five days increased from 5,133 to 5,923.
- That’s an increase of 15%
Dr. Richard Frazee, quoted in Science Daily, reported that getting surgeons to change their prescribing patterns was challenging:
“To change surgeons’ behavior, you have to convince them that it is a benefit to their patients. We had to overcome many years of misinformation on the ‘safety’ of liberal use of opioids after surgery…this program offers a model for other health-care systems and individual surgeons to adopt in the care of their patients”
This effort is a positive step in reversing the practice of opioid over-prescription and addressing its relationship to long-term opioid use and OUD. To measure the effect of this initiative on rates of OUD in central Texas, additional studies will be required. The goal is not only to reduce opioid prescriptions, but to reduce the damage that opioid addiction causes individuals, families, and communities.
We’ll keep an eye on the situation, and report on the effect of this initiative when researchers or public health officials publish any new data. In the meantime, we’ll keep fingers crossed in hopes that this initiative mitigates the effect of the opioid crisis in Texas.