According to the Centers for Disease Control and Prevention (CDC), more than 130 people die every day from opioid overdose — both from prescription and illicit drugs — and at least half of all deaths involve a prescription opioid.
Opioid abuse was a central focus of the 2019 Centers for Medicare & Medicaid Services (CMS) Quality Conference, both on the main stage and in breakout sessions with experts.
Following are four takeaways and lessons learned on confronting the opioid epidemic.
1. Leverage CDC Guidelines for Prescribing
Pharmacists and clinicians alike referenced CDC Guidelines for Prescribing Opioids for Chronic Pain. The three main focuses of the guidelines are:
- Determining when to initiate or continue opioids for chronic pain;
- Opioid selection, dosage, duration, follow-up and discontinuation;
- Assessing risk and addressing harms of opioid use.
Sara Shoemaker-Hunt, Ph.D., principal associate at Abt Associates, discussed how her team developed a companion resource to the CDC guidelines, which trains providers on how to best implement them. The resource summarizes the guidelines, discusses 16 related quality improvement measures and includes practice-level strategies to improve management and coordination for long-term opioid therapy.
2. Establish a Patient-Centered Pain Agreement
Laurie Willhite, a Medication Therapy Management Pharmacists with the Heppepin County Medical Center, presented on how to improve opioid stewardship and safety in end-stage renal disease patients. Willhite discussed the importance of establishing pain agreements between patients and providers to ensure patients are part of the process and know what is expected of their pain management. Having clinical pharmacists be responsible for monitoring patient adherence to the pain agreement also keeps doctors from drug testing and allows them to maintain a strong relationship with patients.
3. Address Time and Workforce Challenges
Throughout the sessions on opioid reduction, one of the most frequently mentioned challenges was providers’ lack of time and workforce limitations. Some of the proposed solutions to this barrier included peer-to-peer collaboration, access to training with direct support when needed, and sharing success stories.
4. Establish a Tapering Plan and Support Patients Throughout
Several conference presenters cited a lack of provider assistance in tapering off opioid treatments as a reason why patients can misuse medications. The presenters also outlined ways providers can leverage tools, non-opioid pain treatments and behavioral health to help patients wean off opioid prescriptions.
atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Alabama, Indiana, Kentucky, Mississippi and Tennessee, encouraged nursing home providers to measure specific pain indicators to determine if opioids are necessary in treatment. Amanda Ryan of atom Alliance discussed how the QIN-QIO used tapering and a comfort menu to triple the use of non-opioid pain treatments available in facilities, leading to a 10 percent reduction in residents with opioid orders.