Intermountain Healthcare had a New Year’s resolution for 2018: By the end of the year, cut the number of opioid tablets it prescribed for acute pain by 40 percent.
Ultimately, Intermountain Healthcare prescribed about 30 percent fewer opioid pills for acute pain last year — short of its goal, but part of an “aggressive journey” toward alleviating Utah’s drug addiction calamity, company officials announced Wednesday.
Prescription opioids were behind the bulk of Utah’s opioid-related overdose deaths in 2017, killing 237 of the 360 Utahns who died from either opioid painkillers or heroin.
At Intermountain, improved data tracking for doctors and more explicit discussions with patients about painkiller addiction risks were behind the decrease in pills prescribed, said physician David Hasleton, Inermountain’s chief medical officer.
“I work in an emergency department, and I’ve seen this firsthand,” Hasleton said. “They’re asking us, ‘Doctor, is this the right thing for me?’”
Intermountain in 2017 announced its plan to reduce the number of pills prescribed through its 23 hospitals and 170 clinics in the Intermountain West. Its 40 percent reduction goal focused on prescriptions for acute pain, which had more room for decreases than chronic pain prescriptions, said Intermountain spokesman Brad Gilman.
For all patients, Intermountain prescribed 3.8 million fewer pills in 2018 than in 2017, when doctors prescribed nearly 19 million. That represents an overall reduction of 20 percent.
Doctors in the health care network were asked to consider reducing opioid prescriptions for acute pain from seven to four days worth of pills.
“Physical dependency can occur in just seven days,” said Lisa Nichols, Intermountain’s Community Health executive director.
Officials with the network tracked the number of pills each doctor prescribed and would “initiate a conversation” with those who appeared to be prescribing a large number of opioids. A digital dashboard showed doctors how their prescribing behavior aligned with the norms of other doctors in the network — and in some cases, doctors were writing prescriptions for far more pills than their peers were in similar cases.
“Physician X would prescribe 140 pills after a procedure, and Physician Y would prescribe 30,” Hasleton said. When high-prescribing doctors saw that outcomes and patient satisfaction scores did not suffer for physicians who prescribed fewer pills, they would realize, “I need to be doing something different,” Hasleton said.
A survey of about 70,000 patients showed that “by and large, they only use 50 percent of what they’re given,” Nichols said.
That leaves a lot of unused pills circulating through the public, and that puts people with opioid addictions at risk.
Kelly Howard’s son Billy was one of those Utahns who was suffering from addiction when he died from an opioid overdose in 2014 — while he was not prescribed the drugs.
Ten years before that, Billy’s father also had died of an opioid overdose, and also without a prescription, Howard said.
“When [Billy] decided to leave treatment, he said to me, ‘Mom, it’s just too hard.’ My Billy passed away 10 days later,” Howard said at the news conference Wednesday morning. “My daughter and I were in the intensive care unit when they turned off the machines. He was 26 years old.”
Since 2007, Intermountain has spent about $10 million trying to correct prescription drug misuse, including pharmacy drop-boxes that have received more than 26,000 pounds of unused medication since 2015. The hospital also has distributed more than 1,700 naloxone kits, especially to rural areas. Naloxone is a medication that quickly reverses opioid overdose.
The most telling change health experts noticed was in patient awareness of addiction risks, Nichols said. Patients are more frequently raising concerns in conversations with doctors, and when doctors recommend alternative pain treatments, they’re getting “less pushback from patients than we ever had before,” Hasleton said.
Intermountain has spent about $3 million on a media campaign for addiction awareness, Nichols said, and doctors are trying to make patients more aware of studies that show over-the-counter pain remedies like ibuprofen are more effective than opioids for managing pain in many conditions.
Still, the bulk of the reductions came not from withholding or replacing opioid prescriptions but from prescribing fewer pills. Once the most obvious prescription excesses were addressed, further reductions came more slowly — and Intermountain’s 40 percent goal was pushed back.
“Each percent was exponentially more difficult,” Hasleton said. “We realized we may be (trying to do) too much.”
For 2019, the health care network has set a goal of a 5 percent reduction, which accounts for population growth, Nichols said.
“We really don’t want patients to be in pain,” Nichols said. “As we get to 3.8 million (fewer pills), it becomes more and more challenging to find that balance.”