It is important to address both those already addicted to opioids as well as preventing opioid addiction. For more than 24 years, I practiced as a general internist and treated both types of patients: those addicted to opioids and others who needed medication for chronic pain. For a better understanding of the opioid crisis, consider these four insights.
1. Opioid addiction is a disease
Unfortunately, many people across communities and in healthcare do not recognize opioid use disorder as a disease. Like other chronic illness such as diabetes or heart failure, opioid addiction is not a moral failing, but a complex disease that is very challenging to treat. However, effective, life-saving medication treatment (e.g. buprenorphine, methadone) exists. When combined with mental health and social services, people with opioid use disorder can return to their family and job while living productive lives.
2. Many healthcare systems now target opioid prescribing
Healthcare systems are using data to better understand opioid prescribing patterns and identifying physicians who may be prescribing inappropriately. Health systems use this data for clinician to clinician conversations, education, ongoing monitoring and for accountability. The goal is not to simply reduce opioid prescribing but reduce overprescribing that be harming patients and might contribute to drug diversion.
However, it is important the opioid prescribing pendulum not shift too far, too fast. There are individuals with severe, chronic pain not due to cancer who rely on these medications simply to function. These individuals aren't abusing the drugs and non-opioids don't control their pain. Although treating non-cancer chronic pain with opioids remains controversial (and there is still much we need to learn through research), rapidly reducing opioid prescribing may deprive patients of pain relief. Some patients may even turn to the streets and illicit drugs like heroin, which is frequently laced with fentanyl.
3. Health information technology plays a valuable role in managing and treating opioid addiction
There are a number of tools available to help clinicians make more informed decisions when treating pain. Examples include using state prescription drug monitoring program data to identify “doctor shopping” patients electronic controlled substance prescribing to reduce risk of drug diversion and clinical decision aids such as opioid prescribing guidelines and opioid overdose risk information at the point of prescribing. Analytical options like machine learning, may provide novel predictive tools that identify individuals at increased risk for opioid misue disorder before an opioid is ever prescribed. These tools will only be effective, however, if they are easy to use and seamlessly embedded within clinician workflow.
4. Measuring outcomes
It is important to define meaningful metrics, both for baseline and to reassess the impact of interventions over time. Examples include number of opioid prescriptions by prescriber, opioid quantity, [morphine milligram equivalent] indication. Rates of opioid overdose seen in emergency departments can also provide insight as well as patient-reported outcomes, specifically control of pain.
Dr. Hurwitz will be speaking about the opioid crisis Sept. 20 at Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference. He'll be presenting along with Randy Jernejcic, MD, of University Hospitals of Cleveland. Click here for more information.