How the Opioid Epidemic Began and One Way to End It

Short Attention Span Summary

Policy changes practice
We're in an opioid epidemic.  Many blame JCAHO.  In fairness, JCAHO says it wasn't their fault, even though Purdue Pharmaceuticals, makers of Oxycontin, supported a pain-management educational program organized by the Joint Commission.  In this industry-funded JCAHO guide to pain management, they state, "there is no evidence that addiction is a significant issue when persons are given opioids for pain control.”
Strange today to see this in print, but it was the prevailing view during my training - patients with real pain won't get addicted.  Despite this misinformation, we as physicians ultimately write the prescriptions and need to do what we can to help.  Here is how one ED did just that.

All stakeholders crafted an opioid prescribing policy in a single ED that led to a reduction in opiate prescriptions from 25.7% to 15.5% and a reduction in number of pills per prescription by about 3.  A simple policy change led to marked prescribing changes.

Spoon Feed
ED opioid policies can make a big impact on prescribing patterns in a group of providers and help curb the current epidemic of opiate abuse.

Source
Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy.
J Emerg Med. 2017 Apr;52(4):538-546. doi: 10.1016/j.jemermed.2016.07.120. Epub 2017 Jan 19.

Clay Smith, MD - Twitter

Clay Smith, MD - Twitter


Peer Reviewer Comments

  • What's interesting about the policy that the ED adopted was that it was a very generous guideline using the Washington ED Guidelines. While it encourages physicians to only prescribe enough pills to chronic pain patients until their regular clinic opens, it still allows emergency physicians to prescribe up to 30 days of pills for acute injuries. Despite these broad guidelines, there was still a big reduction in the percentage of patients leaving the emergency department with opioids. I suspect what really matters is getting unanimous buy-in from the group that change is important, which is exactly what the study did. The actual policy may be less important given how flexible the guidelines were.
  • The most sobering statistic from the study is quantifying just how many patients get opioid prescriptions. Even after the wildly successful intervention, over 15% of all patients still left with an opioid prescription. Compare this to my recent experience in Singapore where the opioid prescription rate is 1-2%.
Thomas Davis, MD - Twitter

Thomas Davis, MD - Twitter

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