It’s no secret that the opioid crisis in America has reached epidemic proportions. According to Dr. Amit Mehta, director of the Centre County Community Medicine Department at Geisinger Health Plan, 63,000 people in the United States died in 2016 from drug-related overdoses, including 4,642 in Pennsylvania. That translates to 13 people in the state dying each day from overdoses, with 85 percent of those deaths involving opioids.
In the face of these staggering statistics, Geisinger has developed several programs to help doctors and patients with the prevention and treatment of opioid addiction, which often begins as a result of patients being prescribed strong pain medications.
One of these programs is a pharmacy-led chronic pain treatment program, in which specially trained pharmacists have clinics embedded in Geisinger offices and work closely with Geisinger primary care physicians and specialists to help patients manage pain and their medications, Mehta explained. Geisinger Gray’s Woods office is home to one of these pharmacies.
This is an example of teamwork amongst care providers that Mehta feels is vital in the fight against opioid addiction, and he said that it has been successful so far. Since the program began in 1998, there has been a 26 percent reduction in the number of patients still using opioids at the end of treatment and a 37 percent reduction in the number of patients on the dangerous combination of opioids and benzodiazepines at the end of treatment.
Mehta said a new tool that has been helping physicians and pharmacists to keep track of patients’ use of controlled substances is the Pennsylvania Drug Monitoring Program website.
“With one click, you can see the last controlled drug that was prescribed to a patient, who the physician was that prescribed it and how much of it,” Mehta said. “We can check it and pharmacists can check it; it talks to 17 states and Washington, D.C. So, it helps to prevent multiple physicians giving controlled drugs to the same patient.”
Mehta feels that involving patients in the decision-making process about their own care is very effective. While Geisinger care providers are trained to seek other options for pain relief before resorting to prescribing narcotics or opioids, when the decision is made to put a patient on a controlled substance for longer than three months, both the physician and the patient must sign a Medication Usage Agreement.
“This agreement tells the patient what the prerequisites are for them to be on controlled drugs for short-term or long-term,” Mehta said. “Once we sign that form, we can request the patient do a urine (toxicology) screen to make sure the urine is clear before we start them on any controlled substances. And this can be requested randomly at any time during treatment. ... If things go the wrong way, we will stop prescribing.
“Most patients do not want to become addicted; they just want to get better. So, if we involve them in the decision-making, if we explain to them what the side effects are, and the potential for abuse or addiction, I think patients’ buy-in is much higher, and the positive outcomes are much better.”
Another successful program Geisinger has been using locally is the Medicine Take-Back Program, with the goal of getting unused prescription opioids off of the streets. Under this program, more than 20 take-back boxes have been placed at Geisinger facilities across the state, including Gray’s Woods. The boxes are places for people to dispose of their unused or expired medications in a safe way.
Mehta said the program has collected more than 10,000 pounds of medications, 15 percent of which are opioids.
“We don’t want these drugs ending up in the wrong hands. ... It also reduces the environmental effect, because these medications can end up in the rivers and forests.”
Other programs Geisinger has launched include Medication Assisted Therapy programs aimed at helping patients who already are addicted or at risk of becoming addicted to opioids, and a social media educational campaign called “We’ve #HadEnough, Have You?” In addition, Mehta said, researchers at Geisinger are studying topics such as the genetic risks of addiction, and Geisinger has established the only accredited Fellowship in Addiction Medicine in Pennsylvania.
According to Kirk Thomas, chief administrative officer of Geisinger Western Region, “While we want to effectively manage our patients’ chronic pain, we are putting measures in place to ensure our staff is trained to both prevent new cases of addiction and treat existing cases. Since 2014, Geisinger has reduced controlled substance prescribing in ambulatory settings, including emergency departments and community practice locations, by half, from 60,000 to 28,000 per month.”
Mehta said that positive results like these are reasons to be hopeful about the fight against the opioid crisis.
“There is no doubt this is an epidemic. And there is no doubt that we all have to work together as a team, otherwise we are not going to be successful. ... But, there is light at the end of the tunnel. Just by showing the more than 50 percent reduction in the number of controlled substance prescriptions achieved by working together as a team, that’s one example that it can work,” he said. “Having said that, a lot of work needs to be done. This is a fight on a daily basis. It’s really, really hard work.”