As opioid addiction and overdose rates continue to rise across the country, Essentia Health is making an unprecedented effort to reduce the number of its patients who rely on prescription opioids — and it’s working.
In the five years between June 2014 and June 2019, the number of Essentia Health patients who were on prescription opioids for chronic pain decreased by 52%.
In that same time frame, the number of new patients who were prescribed opioids for chronic pain dropped by 64%. There has also been a 30-40% drop in the number of surgical opioid prescriptions, as well as a drop in emergency room opioid prescriptions.
Those figures are system-wide across Essentia Health, which has multiple health care facilities in the Midwestern states of Minnesota, Wisconsin and North Dakota, including the hospital and clinic in Detroit Lakes.
“We continue to see a decrease in the amount of patients on chronic opioid therapy, and a decrease in the amount of people who are becoming dependent on opioids,” said Dr. Joe Bianco. “I’ve been happy with where we’re going, but there’s still a long way to go.”
Bianco, who practices at Essentia Health clinics in Virginia and Ely, is a leader of Essentia's Opioid Stewardship Program, which is key to the organization’s efforts to address the opioid epidemic. The program is a concerted effort, across the Essentia Health system, to take a more comprehensive approach to pain management and addiction.
In place for about six years now, the program has embedded new philosophies and guidelines about opioid prescriptions into Essentia Health’s standards of care. The program focuses on educating both patients and providers about the safety and effectiveness of opioids, and turns more attention to alternative pain medication and treatment options.
“We’ve focused first on changing the way that people are prescribing opioids,” Bianco said. “We’re primarily working with ... patients who’ve been on opioids for a long time, for some kind of chronic pain condition. We wanted to work with the patients to reduce the amount of opioids that they are on, or provide an alternative type of plan for their pain.”
Kelly Black, the Duluth-based manager of the Opioid Stewardship Program, said, “We know based on national data that one in four patients on long-term opioids have opioid use disorder. That’s why chronic use is so important to our strategy.”
Other strategies of the program include:
- Enhanced monitoring and screening of patients who are on long-term opioids, to watch for signs of addiction;
- reaching out into communities to share resources and information (such as with law enforcement);
- taking steps to reduce stigma around opioids so that people who need help will be more apt to seek it,
- and offering more recovery services and support for people with opioid use disorder.
One of the common misconceptions about opioids is that “all opioids are bad and everyone should get off,” said Bianco, but "that's overly simplistic." The Opioid Stewardship Program is not about taking opioids out of the hands of every patient.
Instead, the approach Essentia is taking is more multifaceted and patient-specific, with providers considering the appropriateness of opioid prescriptions on a case-by-case basis.
“We don’t want to make things worse for patients,” Bianco said. People who live with chronic pain can find it “very, very scary” to think about leaving opioids behind, and providers are trained to be sensitive to that.
In most cases, the decision of whether to take a patient off opioids, or of whether to prescribe opioids in the first place, is not an easy one.
“Opioids and pain have always been difficult for clinicians,” Bianco said. “Pain is a difficult condition to take care of because it presents itself in different ways. Understanding pain — the physiology and behavioral health aspect of it — is incredibly important and takes a lot of time for clinicians.”
The Opioid Stewardship Program aims to help clinicians in this endeavor by offering support, education and standardized prescription guidelines.
“We’ve been trying to support our clinicians in making the right choice, and they’ve been very happy to have the help,” Bianco said. “The reaction has been very, very positive.”
Essentia is ahead of the game in its efforts; the Minnesota Legislature just passed a law in its 2019 session requiring all clinicians to have at least two hours of opioid training before they can be licensed.
“We’ve actually created the curriculum for them,” Bianco said.
Looking ahead, the focus of the Opioid Stewardship Program will be on increasing access to prevention, treatment and recovery services for opioid use disorder. Essentia also plans to increase its collaborative community efforts, in hopes of making a broader difference — not only with prescription opioids, but with illegal opioids, as well, which make up the majority of overdose deaths.
“There are still huge challenges out there,” Bianco said.
The prescription opioid problem
Millions of Americans suffer from pain and are often prescribed opioids to treat their conditions. However, the dangers of prescription misuse, opioid use disorder, and overdose have been a growing problem throughout the U.S.
Since the 1990s, when the amount of opioids prescribed to patients began to grow, the number of overdoses and deaths from prescription opioids have also increased. Even as the amount of opioids prescribed and sold for pain has increased, the amount of pain that Americans report has not similarly changed.
46 people die every day from overdoses involving prescription opioids. In 2017, prescription opioids were involved in more than 35% of all opioid overdose deaths.
Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.
From 1999 to 2017, almost 218,000 people died in the U.S. from overdoses related to prescription opioids.
The most common drugs involved in prescription opioid overdose deaths include methadone, oxycodone and hydrocodone.
Source: Centers for Disease Control and Prevention