Intermountain Healthcare announced Tuesday it will be doling out fewer opioids during the next year and a half, with a goal of dramatically reducing how many pills the Utah-based health care system prescribes for acute pain.
The move, aimed at cutting the number of opioid tablets prescribed by 40 percent by the end of 2018, comes as opioid addiction use and overdose deaths are skyrocketing across the U.S and in Utah. And it could have a sizable impact, given Intermountain’s reach through its 22 hospitals and 180 clinics in the Intermountain West.
Intermountain officials said they plan to not only alter the prescribing practices of its physicians, but also develop and recommend alternative forms of pain management to patients, further lowering addiction risks.
One of the health care network’s top leaders said they recognized the risk of putting a hard number on the opioid reduction goal, but intend that as a way to hold themselves accountable.
“Intermountain is not going to be intimidated anymore. We won’t be timid anymore,” said Todd Allen, acting chief quality officer for the network of hospitals and clinics. “We plan on making a big difference.”
Nearly 2,500 Intermountain physicians, nurses and other prescribers have already been trained on opioid-reduction strategies, Allen said. The network will now get that training to its staff across Utah and Idaho.
Patients with acute and chronic pain conditions will still receive the medications they need despite the opioid-reduction campaign, said Doug Smith, associate medical director for Intermountain, but prescription decisions will be made differently.
“Currently, nationwide, providers tend to write prescription for more opioids than patients need, and large quantities of the medications are often left over after the need for pain relief has past,” Smith said. “We will follow best practices in prescribing so the medication prescribed more closely match the needs of patients”
Intermountain also will track opioid prescriptions electronically, Allen said, so prescribers can be held accountable and learn from each others’ practices for specific pain conditions. Physicians and nurses will also develop new standards for pain management that incorporate other forms of treatment, including physical therapy and holistic therapies.
Intermountain is focusing on acute pain cases — involving pain that will eventually pass but needs to be controlled — because those can be treated with other therapies rather than opiates. Allen said acute pain might be associated with a broken wrist, kidney stone or abdominal inflammation.
In 2015, 24 people died each month in Utah from prescription opioid overdose, according to Utah Department of Health data. From 2013 to 2015, Utah ranked seventh in the nation for drug overdose deaths.
The Centers for Disease Control and Prevention reported that more than 33,000 people died from unintentional overdoses involving opioids in 2015. Nearly half those deaths involved prescription opiates.
In 2015, UDOH reported that more than $2.65 million opioid prescriptions were dispensed in Utah – about 7,200 per day. From 2002 to 2015, the rate of opioid prescriptions increased dramatically from 686 to 888 to 1,000 state residents.
About 19 million opioid tablets are administered each year by Intermountain prescribers. In many cases, Allen said the majority of those tablets go unused and are left over in a patient’s medicine cabinet.
Educating patients and the public about the dangers of keeping unused opioids and the risks of taking opioids — prescribed or not — will be a key factor to Intermountain’s success, Allen said. Prescribers will be encouraged to talk about addiction and the risk of use with patients before prescribing and will have strategies and resources from several public health agencies on hand.
The Utah Department of Health has launched several campaigns to combat the opioid epidemic in recent months. The agency held a talk to your pharmacist initiative in the spring; began a pill-bottle labeling campaign to warn patients about the contents of prescriptions; and created an online resource, Opidemic.org, explaining what opioids are, their effects and how to get help.
The U.S. Department of Health and Human Services issued $5.5 million to Utah in May to create and expand opioid addiction-related programs and services on the county level. The one-time money is being distributed through the Utah Division of Substance Abuse and Mental Health Services.
Intermountain’s health professionals will continue to emphasize disposing of surplus pills, Allen said. Intermountain pharmacies have drop boxes for leftover prescription drugs and, since 2015, more than 15,000 pounds of unused medications have been collected.
Intermountain also plans to expand services to better help patients with chronic pain and addiction problems, through its pain management clinics and with additional treatment for opioid-use disorders.
“With education, we are offering to give patients a gateway to initiate a conversation [about opioids],” Allen said. “They want to be part of their care and want to avoid the risks of medications that could harm them.”