Research Exercise: Opioid Crisis

HSA 300

Research Exercise: Opioid Crisis

The opioid crisis is a subject that hits my heart because I lost a sister in November due to this. The opioid problem in this country has become a huge epidemic. According to the CDC between 1999 and 2015 there have been more than 183,000 deaths from opioid overdose. Opioid prescribing in my opinion is an inevitable evil as we are faced with the difficulty of alleviating pain while at the same time trying to curve over prescribing and abuse. As the manager of this special task force to tackle the opioid epidemic in this country, I believe that we need to do all we can to take control of this crisis; including looking at what some of our partners in public health are doing.

The CDC has been researching ways and methods to lower or even prevent opioid deaths. In keeping with that effort, the CDC has identified two areas of concern that would need to be addressed, if we are to begin to address this epidemic. 1) Opioid prescribing guidelines for physicians and 2) ways hospitals can create a prescription drug monitoring program.

The case study I chose is “Treatment Innovation in Orthopedic Surgery” conducted by Seth A. Waldman, Joseph R. Schottenfeld, and Abbe R. Gluck. The study has come to the conclusion that most opioid prescriptions are initiated in specialty hospitals and clinics, and are usually for elective surgery. They also concluded that a lot of these conditions that are being treated through surgery may already have been prescribed opioids prior to the operation. This creates a problem for post-operative pain management because those patients develop hyperalgesia (enhanced pain response) which can lead to persistent pain and poor surgical outcomes.

As a result of these findings, the researchers came to the conclusion that the approach of Hospital for Specialty Surgery (HSS) in New York is a good model for minimizing opioid use and possibly reducing its increased death rate. HSS has adopted a two step approach to help them take control of this problem: Intensive Education and Active Monitoring. The usefulness of this article cannot be overstated; so it should be dispersed to everyone in the QM department to form the basis of a policy on opioid prescription and use.

Another use for this article would be to make it available to hospitals. Every hospital is struggling with the same problems regarding opioid over prescription and misuse; but may not have the tools to begin to properly and effectively deal with the problems. This article as a tool, identifies a set of five questions, which if asked by the post-op prep team of any hospital will quickly identify patients whose situation may need further review or even a tox screen.

In conclusion, this article if followed all the way through correctly can form the basis for a successful effort in the fight to decrease the rate of opioid overdose and related death rate in the entire world. The article starts first with educating and encouraging doctors to ask the patient five questions to determine facts that would help the post-op surgical team create an accurate profile of the patient. When patients truthfully answer these questions, the team will be able to determine whether the patient has ever taken pain medications, how long they have been taking pain medications, and why, if they use illegal drugs and what type, if they drink alcohol and how much and how often and if they have ever been in detox for drugs and/or alcohol, etc. Knowing the answers to these questions is crucial in determining a person’s risk factor for opioid abuse and their pain threshold. The next thing they need to do is develop a customized process for anesthesia for the patient based on responses from the questionnaire to minimize opioid use post-op. There are several other tools like surveillance and encouraging doctors to consult the Prescription drug monitoring programs (PDMPs) prior to writing opioid prescriptions for patients. Therefore, this article will be very useful in the opioid overdose prevention portion of the QM department.

References:

Schottenfeld, J. R. ., Waldman, S. A. ., Gluck, A. R. ., & Tobin, D. G. . (2018). Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis. Journal of Law, Medicine & Ethics, 46(2), 220–237. 

https://doi.org/10.1177/1073110518782923