Tackling the opioid crisis, one prescription at a time

Tackling the opioid crisis has been a challenge for some years now. In fact, it's an epidemic that causes nearly 17,000 deaths in the U.S. each year. That's more deaths related to overdoses than from motor vehicle accidents. Thankfully, recent initiatives are beginning to mitigate the effect of this huge epidemic — starting with the problem of defining appropriate opioid prescribing patterns.

Several years ago, a group of Kaiser Permanente doctors and other clinicians in Northern and Southern California identified a need for education. They dedicated their efforts to provide information and tools to assist physicians to improve opioid prescribing practices.

The challenge is that there's no simple solution. For some patients with certain types of pain, these drugs are needed. But for other situations, there are alternative pain management methods, including substitute medications, physical therapy, acupuncture, and incorporating healthier lifestyle practices.

"Not prescribing is as bad as over-prescribing," Paul Gileno, president of the U.S. Pain Foundation, an advocacy organization for chronic-pain patients, told The Atlantic. "We don't want all or nothing. We want that balance."

To strike this balance, Kaiser Permanente physicians were educated on safe opioid prescribing and monitoring of patients, preventing recreational use and alternatives for chronic pain management. They reprogrammed computers to alert doctors about how to prescribe certain opioids and about the risk of abuse. A separate alert now appears if the patient is also on benzodiazepines or muscle-relaxing medication (a dangerous combination with opioids).

In Northern California, Kaiser Permanente's East Bay emergency departments joined the East Bay Safe Prescribing Coalition — a collaboration of all 20 emergency departments with the goal of improving opioid safety in Alameda and Contra Costa counties. Other community initiatives like the Santa Clara Opioid Overdose Prevention Project are looking to expand provider education for opioid prescribers.

In 2016, California lawmakers passed a law to require doctors to check a statewide database, CURES, to see if their patients have received opioid prescriptions from other doctors. The law is currently under federal review, but if it goes into effect, it could do even more to fight this crisis. The Medical Board of California also issued updated guidelines on safe opioid prescribing.

Students at the University of California, San Francisco are also researching ways to improve safety for those using opioids. With high rates of overdose affecting people across the nation, many of the students advocated for the use of naloxone, a medication that can reverse the effects of an acute opioid overdose. The students work with nurses, physicians, and pharmacists to create opioid safety agreements for doctors’ offices, and emails designed to remind doctors to order and use naloxone.

Federal agencies are taking the opioid epidemic seriously, too. Last year the Centers for Disease Control and Prevention established new guidelines: Doctors should prescribe non-opioid medications first before looking at other options.

Hopefully, through these various programs the United States can tackle the epidemic from all angles. And we can use Kaiser Permanente in Northern and Southern California as an example of success. Five years in, they've seen a dramatic decrease in opioid prescriptions.

Reducing opioid prescriptions while still managing patients' pain remains a major challenge for doctors and patients alike. But this progress is a big step in the right direction.

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