We have been fighting an opioid epidemic since the late 1990s. In 2017, the U.S. Department of Health and Human Services (HHS) declared a public health emergency and released a five-point strategy to combat the opioid crisis. A quarter of a century since it started, and fentanyl, a potent synthetic opioid, is the leading cause of death for ages 18 to 45. The CDC reported 79,770 opioid-involved drug overdose deaths for the 12-month period ending in December 2022. I needed a visualization to appreciate this number. The Notre Dame football stadium holds 75,000.
Nearly 645,000 people died from an opioid overdose between 1999 and 2021. That will put us at close to 1 million deaths by the end of 2023. This is too big of a number to capture with a picture. Imagine the city of San Jose (population 1,026,908).
We have an epidemic that is into its third decade! Opioid Use Disorder (OUD) affects people of all ages, races, sexes, and socioeconomic statuses. This multifaceted, multi-waved, public health crisis has grown and evolved over the years. It's costing lives and costing dollars. There is more than $1 trillion spent on the opioid health crisis each year.
Regardless of what this crisis has turned into, the facts remain. Studies show that 80% or more of people who used illicit opioids started on prescription opioids. This epidemic began with prescription opioids (first wave). Approximately 3-19% of people who take a prescription opioid medication develop an OUD. People with OUD have a 10x higher rate of mortality.
Let’s put this information into context. I will run it through my pharmacist lens. Your local pharmacist counsels you on your new medication and tells you:
“If you take this medication, you have around a 10% chance of developing a chronic condition. If you develop that condition, you are 10x more likely to die.”
As a patient, does this change your thoughts on wanting to take that medication? As a prescriber, does this change your thoughts on who to prescribe that med to? I think we can agree, healthcare has an opportunity – a responsibility – to assist in combatting the opioid epidemic. This is a complex healthcare and public health issue. We need all hands on deck.
What Can Healthcare Do?
Here's something - Opioid Stewardship. Opioid stewardship in a healthcare organization is a coordinated program that promotes appropriate use of opioid medications, improves patient outcomes, and reduces the misuse of opioids. These programs focus on safe prescribing practices for opioid medications and ultimately help prevent opioid use disorder while treating patient pain. The goal of opioid stewardship is to help providers balance pain management and harm reduction. A well-designed program allows providers to meet individual patient needs while mitigating risks of addiction and harm.
Here is another fact. A recent study completed by the American Society of Health System Pharmacists found that only 41% of hospitals they surveyed had an active opioid stewardship program in place. Another study found that only 14% of hospitals reported a prospective screening process to identify patients at a high risk of opioid-related adverse events. There is work to be done here.
If we know that opioid prescriptions have a 10% risk of OUD, shouldn't we be monitoring our prescribing practices? Yes! This is critical work. Having a leadership strategy that assists interprofessional healthcare providers in delivering best practices is necessary.
The American Hospital Association published Stem the Tide in 2020 as guidance for health systems to develop and implement a robust opioid stewardship program. The guide is an actionable resource to implement best practices in a data driven strategy for opioid stewardship.
Use Data to Drive your Opioid Stewardship Program
Opioid Stewardship Programs are data driven. An EHR and third-party tools can assist in the process. A common barrier to stewardship programs is resource allocation. Healthcare is always striving to do more with less. To empower your leadership team, you need a comprehensive data analytics solution - a single source of truth. Your opioid stewardship solution should allow leadership to efficiently identify opportunities, focus on high-risk categories, use comparative analytics, identify outliers, and monitor program success over time. PharmASSIST Healthcare Dashboards (PHD) can help you every step of the way on your Opioid Stewardship journey. Our team is well-versed and well-equipped to help in this space. Our custom analytics are the answer for an accurate and efficient, data-driven strategy in opioid stewardship. Visit our website (www.phddashboards.com) for more information.
The Opioid Prescribing Dashboard PHD created for our practice is 10X better than any other tool out there. It is changing our prescribing practices - it is working! Every healthcare system needs this tool.”
- Medical Director of Controlled Substance Monitoring Team