Report from HIMSS19: Novel Techniques to Combat the Opioid Misuse Epidemic

Every day, more than 130 people in the United States die after overdosing on opioids.¹ The misuse of and addiction to opioids is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.²

Canada is also experiencing a serious opioid crisis. More than 9,000 people lost their lives in Canada between January 2016 and June 2018 related to opioids. The opioid epidemic has affected every part of the country; however, certain regions have been impacted more than others. Based on available data, there were 2,066 apparent opioid-related deaths in Canada between January and June 2018; 94% were accidental.³

During the recent HIMSS meeting in Orlando, FL, several leading organizations shared their institutions’ efforts to combat the opioid epidemic. While the specific tactics employed varied among institutions, common themes were also employed, including the establishment of a clear governance structure, clinician education, incorporation of best practice into the clinician workflow and pre-established outcome measurements.

One U.S.-based site provided a summary of ongoing initiatives to decrease overall opioid prescribing and increase more appropriate prescribing within their organization.⁴

Efforts included:

1. Patient education programs regarding how pain treatment would be managed within the emergency room and ambulatory environment
2. Implementation of an opioid misuse risk assessment tool for all patients
3. The deployment of different opioid misuse monitoring strategies depending on a patient’s risk assessment
4. The calculation of a patient’s total opioid daily dose using morphine equivalent daily dose (MEDD)
5. Direct integration with their state’s prescription drug monitoring program,
6. Innovative non-drug approaches to pain management
7. Non-opioid surgical procedures

The health system demonstrated a decrease in the overall number of opioid prescriptions dispensed, decrease in the average MEDD/Rx and an increase in adherence to guidelines across multiple settings of care.

A Canadian-based site reported on their efforts to improve the appropriate prescribing of buprenorphine/naloxone to patients presenting to their emergency room for opioid withdrawal, via the development of an interdisciplinary pathway and order set.⁵ Post intervention, the health system demonstrated increased rates of initiation of buprenorphine/naloxone therapy, a decrease in repeat visits to the emergency room for opioid withdrawal patients, and a decreased average wait times between emergency room visit and coordination of care for after visit services. 

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References:

1. CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.
2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.
3. https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/data-surveillance-research/harms-deaths.html
4. Burstain, T. (2019) ‘Leveraging EHR for Opioid Stewardship’. Presented at HIMSS19.
5. Bucago, C, Paterson J. (2019) ‘Treating Emergency Room Opioid Withdrawal with Buprenorphine’.  Presented at HIMSS19.