Scripps Health Launches Opioid Stewardship Program

Education to play key role in program's initial phase

Opioid-based painkillers

Education to play key role in program's initial phase

Scripps Health has launched a program that aims to significantly reduce the use of opioids in order to help prevent patients from overdosing or becoming dependent on the powerful pain-reducing medications. Greater use of non-opioid approaches for pain management will be emphasized.

“We can and must do everything possible to reverse this dangerous trend, starting by limiting and monitoring post-discharge opioid usage, and using other proven and effective methods to manage pain,” said M. Jonathan Worsey, MD, co-chair of the surgery care line at Scripps Health and one of several physicians leading the Scripps Opioid Stewardship Program (OSP).

Key elements of the new Scripps OSP include:

• Educating patients about opioids, including setting realistic expectations for post-surgical pain, how to taper off and maximize other types of pain management and safe disposal of unused opioids.

• Educating medical staff on safe and appropriate opioid prescribing and increasing the role of pharmacists in managing post-operative opioid use.

• Expanding training and use of multimodal pain management, including non-opioid medications such as acetaminophen and ibuprofen, and non-pharmaceutical techniques such as ice or heat, physical therapy, meditation, massage and distractions.

The program at Scripps comes at a time of a nationwide opioid overdose epidemic that has been fueled in part by prescription opioids. According to the Centers for Disease Control and Prevention, 40 percent of opioid-related deaths involve a prescription opioid, including drugs such as oxycodone, hydrocodone and methadone. Each day more than 1,000 people are treated in emergency rooms for misusing prescription opioids, according to the CDC.

Preventing dependency

The program will initially focus on educating patients to prevent them from becoming dependent on opioid medication. Informational handouts are now available to Scripps Mercy Hospital’s elective surgery patients before their procedures, explaining the best way to manage acute pain is with non-opioid medications and drug-free pain relief techniques. The handouts also explain that opioids should be considered only after other non-opioid approaches have been tried. Patients are also being advised on safe disposal of unused opioids.

Following the program’s launch and growth at Scripps Mercy Hospital’s campuses in San Diego and Chula Vista, plans call for an expansion to other Scripps hospitals, likely starting with elective surgery and then spreading to other departments via inpatient nursing units. Scripps also envisions sharing the handouts at its affiliated doctors’ offices and retail pharmacies.

“Our goal is to return patients to healthy function as soon as possible without putting them at risk for opioid dependency or the side effects of opioid usage. This means taking advantage of all other pain management options before considering opioids,” said Valerie Norton, MD, medical director of the emergency department at Scripps Mercy Hospital San Diego and medical director of the Scripps Health Pharmacy and Therapeutics Council.

The program’s initial phase also will focus on educating health care providers. A formal education module will be prepared for physicians and pharmacists and an online OSP resource center has been created to centralize prescribing tools, community resource information and patient and provider education materials. The initial phase also includes the establishment of a prescribing standard, which limits the number of opioid tablets issued in prescriptions and encourages the use of tapering schedules and partial prescription fills.

Looking ahead

Other future efforts of the program will include adding decision support for opioid prescribing through Scripps’ new electronic health record system; use of formulary management and pharmacist authority to lower prescribed doses for patients new to opioid use, and sensitive patients moving through the acute-care setting; and a take-back program for unused opioids.

Later phases of the program will address chronic and complex patients who are already opioid-dependent to make sure they have access to appropriate treatment.

The Opioid Stewardship Program is led by a multidisciplinary group of clinicians who received a HealthTrust innovation grant last year to build a program to manage surgical pain with minimal use of opioids. In addition to Drs. Worsey and Norton, the steering group includes David Dockweiler, MD, co-chair of the Scripps surgery care line; Melissa Flaherty, clinical pharmacy director and co-chair of the systemwide pharmacy and therapeutics council; and Emily Hernandez, clinical resource specialist for supply chain management.

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