In 2015, 90 people died each day from an opioid overdose. If you subtract deaths attributed to heroin and synthetic opioids sold on the street, that still leaves 42 deaths daily from drugs prescribed by a licensed health-care professional. How did we get here?
It’s complex, with many factors contributing to the changes in prescribing. But what we can all agree on is that many opioids being prescribed may not be necessary. Too often they are abused and misused by the patients for whom they are prescribed, or they end up in the hands of others.
The good news is we are already seeing a downward trend in opioid prescribing rates. The bad news is we are still prescribing far more than we have in the past. This is where the development of opioid stewardship programs comes into play. As a pharmacist who regularly discusses this topic with physicians and clinicians, I have broken those recommendations down to the following key strategies for building a successful opioid stewardship program.
- Prepare a patient-provider agreement. This agreement is a commitment between the provider and the patient on how pain will be managed and, in my opinion, is one of the most essential components of a good opioid stewardship program. The PPA is the basis for consistent communication between the provider and the patient. It should focus on the patient and provider, not the opioids. Using patient-centered, non-punitive language, the PPA should include required treatment goals, components of the monitoring program, risk and benefits of the prescribed therapy and exit plans based on patient actions and efficacy. I recommend including key health-care team members, patients (including patient-family councils), hospital leadership and risk management in the development of your PPA.
- Provide the right data to physicians. Having data to monitor population and provider-level outcomes such as the percent of patients on opioids, the percent of patients on high doses and patients receiving an opioid and benzodiazepine combination will be very important. This data is also important to monitor progress in reducing opioid prescriptions.
- Establish an organizational policy for prescribing opioids. I recommend that opioid prescribing guidelines be a part of an organization’s larger pain-management plan and include not only guidelines and criteria for opioid use but also non-pharmacologic and non-opioid treatment options. CDC guidelines provide recommendations regarding considerations for non-pharmacologic and non-opioid therapy, use of immediate-reaction versus extended-release products and initial dosing strategies.
- Establish a risk-assessment process for providers. I get many questions about risk-assessment tools. From a practical standpoint, these tools allow one to establish a consistent process for physicians to use to assess patients prior to initiating therapy.
These are just a few critical components to start the process of developing a comprehensive opioid stewardship program. By working together the health-care industry can make a significant impact in reducing the number of opioids available and save thousands of lives.