Consider this statistic: In 2015, the amount of opioids prescribed was enough for every American to be medicated around the clock for three weeks. Say it aloud and your brain will have a hard time accepting what your mouth is telling it. The amount of opioids prescribed was enough for every single American to be medicated around the clock for three weeks.
To get a better perspective on the opioid epidemic, I recently sat down with Dr. Jason McElyea, director of medical education and program director, family medicine residency at McAlester Regional Health Center in Oklahoma. He is on the front lines of this crisis and he shared some insight into what he is seeing and how he is modifying his prescribing practices to help combat addiction, one patient at a time. The following is an excerpt from our conversation.
Jodi Eisenberg: What was your reaction to the CDC Vital Signs report on opioid prescribing? With respect to the current opioid epidemic, what has had the biggest impact on you?
Jason McElyea: I saw the report as a call to arms. Working in a small town like McAlester, this is something I encounter in approximately 10 percent of my daily appointments; whether it’s someone suffering from side effects of opioids or addiction, or they’re trying to get more pain medication. But there are many non-narcotic options available to patients with chronic pain that are highly effective. In my opinion, physicians owe it to their patients to stay abreast of safer options. They can do this by reading and researching more about the latest developments in non-narcotic treatments and medication strategies.
JE: Are you familiar with the surgeon general’s Turn the Tide Rx initiative aimed at health care practitioners and public health leaders? Have you signed the pledge?
JM: Yes, I signed the pledge as soon as I became aware of the program. When the surgeon general first began this campaign, it provided another wake-up call for physicians. As a care provider, you must stop and reconsider your prescribing habits when it comes to opioids. Surgeons may not realize how often they’re writing narcotic prescriptions, at high dosages for long durations. And that’s dangerous – one in 550 people who get a narcotic prescription will die due to their addiction.
JE: In the recent Vizient webinar, “Recognition of Pain and Prescriber Practices across the Continuum,” you discussed methods that have been employed in your organization to educate clinicians, patients and the community, as well as guidelines that were implemented for opioid-prescribing practices. Can you elaborate on those guidelines?
JM: I support my colleagues in surgery practice whose approach is that pain in the post-operative setting can best be managed by setting expectations with the patient through education and clear communication, along with preventative measures in the operating room (such as nerve blocks). We have surgeons who have had success managing the pain of a significant trauma with the minimum opioid dosage for a brief duration, followed by treatment with NSAIDs or adjuncts, such as stretching, bracing and cognitive behavioral therapy.
Nine months ago, the emergency department in my facility looked at our patient data, talked about the epidemic and decided to adopt a non-narcotics policy. The general rule is if it isn’t surgical or broken, the pain should be managed with non-narcotics. We don’t do refills and we don’t treat chronic pain with narcotics. We communicate this policy through printed materials and a consultation with the patient. This policy decreased the amount of high utilizers who arrived with chronic pain complaints and requested refills by more than 80 percent over the course of a year.
JE: Has your organization collaborated with community leaders or other hospitals to raise awareness about the epidemic and strategies that are working in your facility?
JM: In McAlester, I teamed up with Mayor John Browne, who is a strong supporter of addressing the opioid epidemic because he has witnessed the devastating impact it has had on the community. He made it one of the primary agenda items of his administration. We’ve spoken at community forums where members of the audience approached me afterward to confess they didn’t realize they were on too much pain medication. I’m also traveling the country talking about our results at national conferences and seminars. I strongly recommend that physicians talk to the nursing staff in their facilities about this problem; they really are on the front lines in this situation. The main message is we need to decrease the supply of opioids, i.e. drastically reduce prescribing them and increase clinician and patient awareness.
JE: What information do you feel is necessary to help patients understand and prevent opioid addiction?
JM: What I have found to be effective is to acknowledge that they have pain, but then explain the risk versus benefit scenario. I point out how easily narcotics can take hold, as some addictions can occur within as few as three days of taking the medication. I then offer a multimodal method of treatment that includes non-narcotics, NSAIDs and adjuncts.
Vizient has strongly advocated for change on the part of all health care organizations and providers across the country to address the misuse of opioids. Several weeks ago, Vizient applauded the administration’s focus on this national epidemic.
For more information and resources on how to address the opioid epidemic, click here.
To see more details on the work Dr. McElyea has been doing at his facility, in the community and across the country, click here.