The opioid epidemic sweeping the nation and hitting central Pennsylvania hard grew in large part through efforts to manage pain by prescribing pills.
As the prescription medication abuse crisis escalated nationally, the health care community has been taking steps — some innovative — in recent years to curb the epidemic.
Locally, one such effort is Geisinger’s initiative to stay ahead of the pain curve.
The idea is to “prevent acute pain from becoming chronic pain,” said Michael Evans, associate vice president of clinical strategy and innovation and co-director for the Center for Pharmacy Innovation and Outcomes at Geisinger.
“The chances of addiction increase exponentially after the first 30 days” when a patient seeks a refill of pain medication, he said.
In 2013, Geisinger began giving surgical patients prophylactic and non-opioid medication orally prior to incision. The approach began with orthopedic and OB-GYN patients, but it is now used across the health system, he said.
“We use a very limited medical cocktail an hour before incision,” he said. “During surgery and post-op we are already treating the patient for pain.”
The approach has been “extremely successful,” Evans said. “The need for pain medications post-op decreased dramatically.”
In addition to that approach, Geisinger has won accolades for its medication therapy disease management program, which has been in place about 20 years. The program features clinical pharmacists working with primary care physicians to determine appropriate medications and doses to manage pain.
Geisinger has worked with state officials and others in the health care community on a safe prescribing task force to develop detailed guidelines for various practitioners on the safe and effective use of opioids in treating pain.
GAINING MOMENTUM
Among many specifics, the general guidelines note that, “Chronic pain is best treated using an interdisciplinary, multi-modal approach. The treatment team often includes the patient and his or her family, the primary care provider, a physical therapist, a behavioral health provider and one or more specialists.”
In the fall, Pennsylvania became the 49th state to launch a prescription drug monitoring program, a statewide database that allows medical providers to check on whether a patient has received prescriptions from other doctors.
“It’s a huge tool for clinicians to identify people who are doctor or pharmacy shopping,” Evans said.
The law now requires prescribers to check the database every time they prescribe an opioid or benzodiazepine (with some exceptions, such as in an emergency department). In addition, it requires dispensers to input prescription data into the database by the close of the next business day.
Prescriptions of opioids to minors are now limited to seven days, with some exceptions, and also require counseling on risks. Opioid prescriptions in emergency rooms or urgent care centers are also limited to seven days, with exceptions.
Another important step, Evans said, is getting unused prescription medications out of patients’ medicine cabinets and disposed of in a way that does not damage the environment.
Geisinger has a drug take-back program that includes disposal centers. The drugs are picked up by the National Guard and taken to an incinerator. The Geisinger Lewistown Hospital Auxiliary was funding a few boxes locally, but they are not installed yet. Another program through the Centre County District Attorney’s Office has six drop boxes in the county, and Bellefonte Borough also has a drop box.
Evans noted that opioid abuse “has been on a steep incline for quite some time” — locally and across the country.
“It’s been a snowball just continuing to grow,” he said.
But he sees progress in the fight to curb abuse.
“We have a lot of momentum now,” Evans said. “Education for our community is one of the key points — to understand that the risk of addiction is much higher than we ever thought.”
