Intermountain Healthcare has set a goal of reducing opioid prescriptions for acute pain by 40 percent by the end of 2018—the equivalent of 5 million fewer pills.
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According to a press release, the initiative makes the health care system the first in the country "to formally announce such a significant and specific amount of [opioid] reduction as a target."
Background
According to Deseret News, an average of 91 U.S. residents die every day from an opioid overdose. And Utah—where Intermountain is based—had the ninth highest rate of drug overdose deaths in the country as of 2015, with 23 deaths per every 100,000 residents. Lisa Nichols, the community benefit director for Intermountain, said more than 80 percent of those deaths consist of people who became addicted to heroin after using prescription opioids.
Currently, according to Nichols, Intermountain's 22 hospitals and 180 clinics prescribe around 12.5 million opioids for acute pain a year.
Doug Smith, associate medical director at Intermountain, said, "Currently, nationwide, providers tend to write prescriptions for more opioids than patients need, and large quantities of the medications are often left over after the need for pain relief is past." He added that going forward, the system "will follow best practices in prescribing so the medications prescribed more closely match the needs of patients."
Intermountain's plan to reduce opioid prescriptions
Intermountain plans to use a "data-driven approach" anchored by a "business intelligence tool" to meet its goal of reducing opioid prescriptions for acute pain by 40 percent by the end of 2018, according to Intermountain CEO Marc Harrison.
The tool enables physicians to monitor prescriptions and get feedback on their own prescribing habits in real time, Nichols said, the health system also is incorporating prompts and default prescription order sets into its EHR system to curb the number of pills ordered. "We want that data to be available really on a very regular basis so people (prescribers) understand how they are doing," Nichols said.
In addition, Nichols said the health system has trained around 2,500 of its employees on how to better prescribe opioids—and plans to expand training to additional providers in Utah and Idaho.
Todd Allen, the director of EDs and the chief quality officer for Intermountain, said sometimes improved prescription habits simply involve frank conversations with patients about why alternative pain treatment is a better option for them, such as physical rehabilitation, or why the system is cutting down on opioid prescriptions overall. Intermountain is "trying to train everybody to have those important conversations. ... Me and my colleagues are not going to be timid anymore," he said.
Intermountain also said it would launch an initiative to help Utah residents dispose of their leftover opioids, citing research showing that about 66 percent of misused opioids came from family members or friends taking them.
But Harrison added while the system "really want[s] to make sure that we reduce the potential for abuse," it will still "ensure that [Intermountain's] patients have high-quality care." For instance, according to Smith, "patients with acute or chronic pain conditions will still be able to get the medications they need. ... We will ensure patients have access to the full range of options to manage pain" (Ross Johnson, Modern Healthcare, 8/23; Mangan, CNBC, 8/23; Lockhart, Deseret News, 8/22; Intermountain Healthcare release, 8/22).
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