On an average day in the United States, more than 650,000 opioid prescriptions are written. Every year, more than 200 million prescriptions are dispensed—enough for each person in the US to have their own bottle of pills. Also consider that between 2005 and 2014, the rate of opioid-related inpatient stays and emergency department visits rose an average of 200% across the country. And that half of the 28,000 deaths from opioid overdoses in 2014 involved a drug prescribed by a physician.
One doesn’t need to pour over statistics to know that the magnitude of the opioid crisis that our country is grappling with is unparalleled—most people can turn on the news, or even look out their front door to see its impact. It will take measures of equal scale to address this public health emergency—and these measures need to be implemented across the spectrum from prevention to recovery.
Altarum’s Health Innovations and Technical Assistance (HITA) team has developed a comprehensive program to tackle this issue at the source—by furnishing clinicians with the knowledge and tools necessary to foster responsible opioid prescribing, improving patient education around opioid use, and providing technical assistance to promote use of prescription drug monitoring programs. In the current climate, where four in five new heroin users start by misusing prescription opioids,2 it’s imperative to institute change upstream, limiting the potential dangers from these drugs. Altarum, in joint-providership with the University of Michigan Medical School and Health System, is implementing this model in Michigan—which ranks in the highest category of painkiller prescriptions per person when compared to other states—with the potential for dissemination to other states and areas of high need.
Building on the effectiveness of HITA’s other medical education programs, the first part of Altarum’s approach is a comprehensive program designed to increase provider competency in prescribing opioids and screening patients for risk of misuse. Clinicians will learn about safe prescribing practices, including fewer doses per prescription and effective alternatives to opioids. The training will also increase providers’ comfort level in initiating these difficult conversations, by providing a framework with recommended questions, interview strategies, and red-flags to watch for in patients. It will also equip participants with evidence-based tools to evaluate patients’ risk and follow-up with those patients who have been prescribed opioids. This program is distinctive not only in its approach—in that it emphasizes prevention and focuses not only on chronic pain, but acute as well—but also in its scale. It is an opportunity for clinicians to earn 20-25 Maintenance of Certification Improvement in Medical Practice (MOC Part IV) and 30-50 Continuing Medical Education (CME) credits for participation. And, as the manager of Michigan’s largest MOC Part IV and CME activity, Altarum is uniquely positioned to deliver this training.
But, providers are only one part of the equation. Altarum is also helping clinicians arm patients with knowledge to promote safe opioid use. The patient education segment of the program is designed to help patients understand the risk of opioid misuse and abuse for both themselves and their family and friends (who might have access to the medication). This is a crucial component as recent data show that three quarters of all opioid misuse begins with people using medication that wasn’t prescribed for them. The course addresses this issue by providing clinicians with guidelines to share with their patients regarding filling prescriptions and storing and safely disposing of medications—ensuring not only the patient’s safety, but the safety of other household members.
The third and key component of this training is teaching participants how to effectively use state Prescription Drug Monitoring Programs (PDMPs)—which will enable clinicians to appropriately monitor new opioid prescriptions, and access patient history to identify potential patterns of misuse. Michigan’s PDMP, which is called MAPS, has recently been improved to offer features and functionality for data analysis and reporting—which will allow clinicians to better monitor opioids being prescribed, providing a greater opportunity for oversight at the state, organization and provider levels. The course will encourage physicians to use the MAPS system, including workflow integration, data analysis, technical assistance, and education in responsible opioid prescribing.
Altarum’s innovative approach to addressing the opioid crisis is unique in methodology as well as scope. The rate of opioid misuse in our country is growing, and it will take efforts on behalf of providers, patients, and legislators to ensure that protective measures are in place. However, there is another side to this issue—providing assistance to those who are recovering from opioid addiction. In an upcoming segment on the Health Policy Forum, learn how another dedicated Altarum team is helping governments more effectively deliver treatment and recovery services to those battling prescription drug misuse and other substance use disorders.