Attacking the Opioid Crisis: Setting the Stage

The vastness of the opioid crisis is all around us. The impact of the opioid epidemic can be felt across all states and confronts us no matter where you look.

Let’s look at some key factors:

• 259 million opioid prescriptions are made every year.
• 91 Americans die every day of opioid overdose.
• Workplace costs of prescription opioid use are more than $25B, driven by lost earnings from premature death, reduced compensation or lost employment, and healthcare costs.

It’s time to take action.

As with any large-scale, complex phenomenon, there is no silver bullet to address this problem. A framework from the Johns Hopkins Bloomberg School of Public Health suggests three areas to focus our efforts: preventing new cases of opioid addiction, identifying opioid-addicted individuals early, and ensuring access to effective opioid addiction treatment. We believe these areas must be attacked from a variety of clinical and operational angles. 

From the clinical side, the emphasis has to be largely around better clinical training and urinary drug testing (UDT). A generation of doctors has been raised based on a curriculum emphasizing the need to manage pain aggressively. Retraining physicians on best practices is needed to reinforce safe opioid prescribing patterns. Research from Utah has shown that physician education on recommended opioid prescribing practices was associated with improved prescription patterns, including 60-80 percent less prescription for long-acting opioids for acute pain. When an opioid is prescribed, the use of UDT is a cost-effective way to monitor treatment compliance and drug misuse.

To address from the operational side, we need evidence-based opioid prescription guidelines in place and systems to track opioid prescriptions and adherence to guidelines. Further, we must ensure access to effective opioid addiction treatment.

Many health organizations and state health systems are aggressively adopting pain treatment guidelines that clearly lay out when opioids should and should not be used. And the preliminary results of implementing these guidelines are promising. For example, the introduction of opioid prescribing guidelines in the workers’ compensation system of Washington state was associated with a decline in opioid prescriptions, the average morphine equivalent doses prescribed, and the number of opioid-related deaths.

Prescription drug monitoring programs (PDMP) allow for health systems to analyze opioid prescribing data to find potentially inappropriate prescribing behavior and illegal activity. For example, using their PDMP, New York City found that 1 percent of prescribers wrote 31 percent of the opioid prescriptions.

While prevention of initial opioid exposure is important, the treatment of opioid addiction is an important safety net when prevention fails. Pharmacotherapies including methadone, buprenorphine and naltrexone are options for routine care of opioid dependence, but they are still at the early stages of the adoption cycle.

The foundation to address the clinical and operational approaches to opioid epidemic is two-fold:

1. a strong system to determine what’s acceptable through well-defined, evidence-based guidelines
2. a system to use these guidelines and trigger the right actions through processes and technology

The next article will address the nature of these two systems.

ABOUT THE AUTHORS

Jayant Lakshmikanthan is the president and founder of CLARA analytics, a division of LeanTaaS. At CLARA analytics, his focus is on using the power of scalable, cutting-edge data science to transform the injured workers’ experience dramatically by shaving off every day/hour/minute in the process of getting them back to being productive. Jayant has architected more than 30 scalable analytic applications and products and holds multiple patents.

Dr. Fraser Gaspar is an environmental and occupational health epidemiologist at ReedGroup, Ltd., based in Westminster, Colorado. His research focuses on the factors that influence a patient’s successful return-to-activity and the use of evidence-based medicine guidelines in improving health outcomes.

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