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Reducing opioid use: Innovations from the ED, the dental community, and the federal government

Many people who follow health care news are aware of the growing and persistent opioid abuse and addiction epidemic the country is facing. According to the US Centers for Disease Control and Prevention, the amount of prescription opioids sold in the US has nearly quadrupled since 1999, without an overall change in the amount of pain that Americans report. Deaths from prescription opioids have also more than quadrupled since 1999. While many stakeholders, including the federal, state, and local governments, hospitals and health systems, health plans, and community organizations are working to combat the epidemic, several promising initiatives are happening in the emergency department (ED) and the dentist’s office.

Last year, St. Joseph’s Regional Medical Center in New Jersey launched a plan to better manage the opioid prescriptions in the ED and find other solutions to treat pain. The Alternatives to Opiates Program uses non-narcotics and advanced pain management strategies when clinically appropriate. The program has led to a 58 percent reduction in opioid prescriptions in the ED. A few other hospitals in the state have implemented the program, as has MultiCare Auburn Medical Center in Seattle, Washington.

Other hospitals have found that transparency about prescribing patterns is an effective solution. The Ochsner Health System in New Orleans, which has approximately 350,000 ED patients a year, started publicizing how often its ED physicians prescribe opioids, along with educating them on non-opioid pain control. Allowing the physicians to have data about the problem and see how they compare to their peers has led to positive changes – the health system decreased prescribing in the ED by 28 percent in one year.

The dentists’ office is another common health care site for treating pain. Dentists prescribe about 8 percent of opioids in the US. Many patients have come to expect strong pain medications to treat pain from common procedures such as a tooth extraction or root canal. In fall of 2016, the American Dental Association issued guidance on the use of opioids, recommending that dentists consider over-the-counter pain relievers first-line therapy for pain. The guidance also encourages dental students, residents, and practicing dentists to seek continuing education in addictive disease and pain management as related to opioid prescribing. Some states are starting to require new dentists and those renewing their licenses to undergo training in best practices to manage pain.

Related: Last week, the White House issued an executive order that creates a high-level commission to combat opioid abuse, addiction, and overdose. The White House will appoint members to serve in the commission in the coming weeks and tasks it with conducting a review of the opioid crisis and recommend new action within three months.

The order calls for the commission to:

    • Identify and describe existing federal funding used to combat drug addiction and the opioid crisis
    • Assess the availability and accessibility of treatment services and identify underserved areas
    • Report on best practices for prevention, including provider education, and use of state prescription drug monitoring programs
    • Review the literature on effectiveness of educational messages for youth and adults with respect to prescription and illicit opioids
    • Evaluate federal programs to prevent and treat drug addiction for their scope and effectiveness
    • Recommend changes for improving the federal response to the drug addiction and opioid crisis

The commission is tasked with developing recommendations for agency heads based on the findings.

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Author bio

Doug leads Deloitte Consulting LLP’s Life Sciences and Health Care practice. With 24 years of experience, he works closely with multiple top health care organizations on major clinical and enterprise transformation efforts and on large-scale technology implementation projects. Doug has extensive experience in comprehensive quality and patient safety transformations, turnaround and performance improvement in academic medical centers as well as organization/workflow redesign and technology enablement. He has served as the lead on a number of enterprise transformation initiatives with some of Deloitte’s most largest and most complex clients.