Regional deaths related to opioid use disorder have been declining as WellSpan Health continues its push to reduce narcotics prescriptions.
Christopher Echterling, MD, Medical Director of Vulnerable Populations for WellSpan Health, sees a “glimmer of hope” in the recent decline in opioid deaths in York, Lancaster, Adams, Franklin and Lebanon counties. Data.pa.gov, which tracks coroners’ reports statewide, shows that after reaching 377 fatalities in 2017, the counties’ combined opioid deaths fell to 315 in 2018. While Dr. Echterling attributes the regional decline to multiple factors, including increased use of Narcan by first responders, he also credits WellSpan’s initiative to decrease the flow of opioids into its communities.
WellSpan has focused on opioid use disorder for close to a decade, and has adopted the CDC’s Guideline for Prescribing Opioids for Chronic Pain. In addition, for the past two years, WellSpan has accelerated its efforts to reduce opioid use by developing more targeted strategies. For example, from 2018 to 2019, a small subset of surgical teams changed their protocol for prescribing opioids at discharge. As a result, 13,000 fewer pills went home with patients.
For these efforts to succeed, patients must be reassured that pain management is still a priority for providers, and one best achieved without opioids.
“We want to recommend treatments that are effective and safe, and opioids are less effective than we originally believed, and extraordinarily less safe,” Dr. Echterling says. “So we deploy them rarely, and when we do, we have a much better understanding with our patients about how they’ll be used.”
“Our goal is always to make sure the patient’s needs are taken care of. But we want to do so in a safer, more effective way.”
— Christopher Echterling, MD, Medical Director of Vulnerable Populations for WellSpan Health
Now, WellSpan Medical Group practitioners almost never prescribe opioids as first-line treatment. In WellSpan’s emergency departments, opioids are not usually prescribed for longer than three days. In its ORs, anesthesiologists are using alternative techniques like regional nerve blocks, increased local anesthesia and preoperative nerve stabilizers to provide better pain relief with less opioids. Nonpharmacologic techniques, such as heat, ice, chewing gum, positioning and aromatherapy, are also being successfully incorporated on the surgical side, Dr. Echterling says.
Using dashboard reports in its EHRs, WellSpan is tracking opioid administration inside its hospitals and at discharge from surgery, with the aim of reducing prescriptions by at least 5% and 10%, respectively, over the next year.
Patients who are prescribed opioids are warned about their risks and directed to use them in conjunction with over-the-counter analgesics, physical therapy or other non-narcotic treatments. All patients taking opioids for longer than 3 months must sign a controlled-substance agreement and undergo regular urine screens. Likewise, patients who meet the standard for high overdose risk are also prescribed Narcan, per CDC guidelines.
WellSpan is improving access to addiction treatment as well. With more than 100 WellSpan clinicians throughout South Central Pennsylvania now certified to prescribe buprenorphine — an alternative to methadone for the treatment of opioid use disorder — patients can get into treatment same-week or even same-day. Providers partner with a community-based recovery organization to help support patients getting to substance abuse counseling. And, WellSpan recently expanded its program to support pregnant women with opioid use disorder and help them and their children after delivery.
“We’re placing a high priority on recognizing opioid use disorder and then treating it with evidence-based approaches,” Dr. Echterling says.
To learn more about how WellSpan Health is participating in the fight to end opioid addiction, visit WellSpan.org/Opioids.