“Force Multipliers”: The Critical Steps Organizations Are Taking to Better Treat Opioid Addiction

With the exception of the Covid pandemic, few crises have perplexed the medical community as much as the opioid epidemic. Thanks to the efforts of groups like the CHIME Opioid Task Force, there’s been a reduction in the number of opioid prescriptions and an increased awareness for treating overdoses.

And yet, the death toll continues to rise. According to the CDC, 11,355 overdose deaths were reported during the 12-month period ending April 2023, compared with 110,394 deaths in the 12-month period ending March 2022.

“Despite all the work we’re doing to try to turn off the spigot, people are still dying. Addiction is still out there,” said Sean Kelly, MD, CMO & SVP of Customer Strategy for Healthcare, Imprivata. “We’re trying to shift our approaches as to how we solve this problem; how we start to get after some of the interventions that can reduce morbidity and mortality.”

One thing that’s become clear? It’s going to take much more than a ‘Just Say No’ campaign, according to the panelists at a CHIME23 Fall Forum session. It’s going to require collaboration across different organizations (especially competing organizations) to share best practices, innovative uses of a technology, and a new way of looking at addition.

Erasing the stigma

For leaders, one of the most important steps is addressing the stigma around addiction and substance use disorders. “It’s extremely detrimental to patients,” according to Scott Weiner, MD, Emergency Physician, Brigham and Women’s Hospital, who believes the healthcare community can play a significant role in changing the narrative. “If someone has ketoacidosis, we don’t blame them for that. We don’t send them to an insulin clinic.”

What’s become clear in recent years is that when it comes to opioid addiction, the treatment is complex. According to the CHIME Opioid Task Force, it “requires long-term, if not lifetime, care from well-informed clinicians who are supported with easy-to-use and reliable tools.”

This is where the Opioid Playbook can play a key role by providing a framework to build IT-based supports for launching and maintaining system-wide initiatives to reduce the disease of addiction in our communities.” Developed by CIOs and CMIOs, the Playbook includes real-world examples, best practices, and links to resources. Within the first few months of its release, organizations like Geisinger achieved quick results; reducing the number of opioid prescriptions per month by half, from an average of 60,000 prescriptions to 31,000, according to (then) CIO John Kravitz.

And that’s just one example from “living document,” which features accounts from various organizations that have leveraged practical interventions to improve outcomes. “It’s essentially a soup-to-nuts blueprint on how to make a difference in your facility, rather than having to reinvent the wheel,” said Kelly.

Lifesaving interventions

Changing prescription habits, according to the panelists, has proven critical. But what’s just as vital — and has become more of a focus in recent years — is automating processes, noted Kelly, who has been an emergency physician with Beth Israel Deaconess Medical Center for more than two decades. “We know that, human behavior being what it is, if we make it easy to follow care pathways that are proven to reduce mortality, they’re going to get done a lot more.” Automated order sets make it easier to stay on course and deploy “lifesaving interventions around harm reduction techniques,” he said.

The Playbook also walks through setting up an opioid stewardship committee, along with dashboards, Electronic Prescribing of Control Substances (EPCS) and Prescription Drug Monitoring Programs (PDMPs), community outreach, education, and change management — which, according to Greg Polston, MD (Associate Medical Director of UC San Diego Health’s Center for Pain Medicine), can’t be underestimated.

In fact, “it’s oftentimes the hardest part,” he said, adding that data and reporting analytics can be very powerful tools for leaders. “We care about patients. When we are shown data that show we’re harming patients, we’ll respond. But without the change engineering piece, the rest of this is very difficult.” To that end, the Playbook offers recommendations on how to effectively communicate with providers as well as patients, and how to drive change.

Of course, even the best strategies have limited potential until they’re shared and adopted across organizations, according to Weiner. “This can’t be happening on islands,” he said. “We need to elevate this and continue to network both internally and externally to show what people are doing. That’s how we can change hearts and minds.”

That, said Kelly, speaks to the heart of what teams like CHIME’s Opioid Task Force seek to do by working tirelessly to spread the word. “If you make a change, even if it’s small, that feeds on itself, and the changes become bigger,” he noted. “That’s the force multiplier we’re looking for.”