Author: Rich D’Amaro, SCP Chief Executive Officer

We all know that opioid abuse and addiction is a national crisis. The epidemic has spread across the country like wildfire, devastating communities, overwhelming emergency departments, and creating unparalleled urgency for hospitals and health systems to respond. Sadly, we also know that providers share some of the responsibility – sources say most addicts got their first dose of narcotics from a doctor, and one out of every 47 patients in the ED who receive a narcotics prescription will become an addict.

In response to this growing crisis, Schumacher Clinical Partners’ senior medical leadership met recently to discuss what we can do to combat the epidemic’s spread. I’d like to share the results of those discussions, outline steps EM providers can take, and highlight what we are doing as a company to impact positive change.

Senate Vote on Opioid Crisis Response Bill

It bears mentioning that the Senate voted this week on an omnibus bill — Opioid Crisis Response Act of 2018 (S.2680) — spearheaded by Sen. Lamar Alexander, R-Tenn., chairman of the health committee, which will tackle the epidemic from several angles. The Senate passed the bill by a vote of 99-1. The bill combines 70 bills dealing with this national crisis and allocates $5 billion in funds to enhance research, treatment, awareness and recovery efforts related to opioid abuse. The bill will improve interagency collaboration on the crisis and authorizes state block grants to help people suffering from opioid addiction. The Senate will now work with the House to reconcile the bills before they can be signed into law by President Trump.

Steps EM Providers Can Take

Alleviating pain has made opioids a mainstay in treatment, but what steps can ED providers take to turn the tide of the national opioid crisis?

At our Medical Leadership Conference held earlier this month in Orlando, FL, one of our keynote speakers, Dr. Josef Thundiyil, Residency Director EM, Orlando Health, and Professor of Medicine, University of Central Florida College of Medicine, pinpointed two areas doctors should focus on: prescribing alternatives to opioids and, when an opioid is indicated, not prescribing long-acting opiates. Even with a 3-days’ worth prescription, there is a six-percent chance the patient will become addicted in a year, he said.

Dr. Thundiyil suggested clinicians follow these best practice guidelines:

  • Prescribe carefully; 
  • Don’t refill lost prescriptions;
  • Don’t treat chronic pain with opiates;
  • Use low doses and short courses;
  • Identify high-risk groups;
  • Counsel patients;
  • Set up a “pain” committee to help with alternative methods.

He also recommended creating an action plan focused on prevention and finding better ways to treat those who are addicted. “Identify the highest risk groups, counsel actively and discuss treatment options, and practice better transitions of care,” he said. “Be restrictive, be cautious, and be aware. Most of all ‘primum non nocere’ — first, do no harm.”

What SCP Is Doing

SCP has a range of initiatives currently underway or in the planning stages that will help keep this epidemic top-of-mind with EM providers. These include:

  • Distribution and promotion of the CMS Opioid Roadmap and ACEP best practices recommendations for opioid prescribing;
  • Contribution of SCP practice data for the national benchmarking project sponsored by ACEP’s E-QUAL (Emergency Quality Network) Opioid Initiative;
  • Educational toolkits and training resources for providers about appropriate opioid screening, prescribing, harm reduction strategies (e.g., naloxone), and medication-assisted therapies;
  • Promotion of “ALTO” — the Alternatives to Opiates Program founded by St. Joseph’s Healthcare network — offering alternative pain strategies to opioids for patients and other education and addiction treatment resources;
  • Expansion of partnership plans with hospital clients for initiatives to help identify barriers to reducing opioid use and misuse. (A pilot program is underway at St. Anthony’s Medical Center in Alton, Ill.);
  • Thought leadership promotion (e.g., blogging, social media) on issues and concerns around opioids;
  • Support of ACEP-sponsored national legislation before Congress, including the Preventing Overdoses While in Emergency Rooms (POWER) Act (H.R. 5176) and Alternatives to Opioids (ALTO) in the Emergency Department Act (H.R. 5197).

Our Education and Training Committee is also working to update the resources and educational content for all providers through our online library, SCP University (SCP-U). In addition to helping providers meet educational requirements, this will give easy access to best practices, practical resources, and authoritative guidance for common opioid issues. Courses are already ongoing at Swedish Medical Center in Englewood, Colorado. 

In addition, we have four lectures on pain management and controlled substances available on SCP-U. Each is 3-5 hours long and certified for CME credits. We are in the process of developing state-specific courses and medical board-approved content as well.

Conclusion

President Trump was accurate when he called the opioid epidemic the worst drug crisis in American history and a public health emergency. We also deem this crisis to be one of grave significance and are taking every step possible to combat its spread.

During one of our leadership meetings, Dr. Randy Pilgrim, SCP Enterprise Chief Medical Officer, stated aptly: "Partnering with local communities, leaders, and patients to positively impact this national crisis goes hand-in-hand with our professional responsibility as clinicians. As trusted specialists, we practice medicine at a critical juncture in the healthcare system. We simply must seize the opportunity to make a difference in this crisis."

This crisis won't resolve itself. As EM and HM leaders, we bear a great weight of responsibility in prescribing alternatives to these highly addictive substances and must seek more and better treatment options for those currently addicted. We are on the front lines in this fight. For the sake of public welfare, it is a battle we must win.

Related Resource:
Advisory Board Infographic: Only You Can Help Confront the Opioid Epidemic - Nine imperatives for hospital and health system execs in mobilizing addiction prevention and pain management strategies and maximizing opportunities to deploy addiction treatment.