In a proactive measure to address the opioid epidemic and strengthen patient safety, HSHS Medical Group has released a new controlled substance abuse policy and agreement. The new policy and agreement are for physicians and patients to ensure safe prescribing and the use of controlled substances.
According to the Centers for Disease Control and Prevention (CDC), the United States is in the midst of an epidemic of prescription opioid overdoses. The amount of opioids prescribed and sold in the US quadrupled since 1999, but the overall amount of pain reported by Americans hasn’t changed. This epidemic is devastating American lives, families and communities.
The statistics are alarming.
More than 40 people die every day from overdoses involving prescription opioids.1
4.3 million Americans engaged in non-medical use of prescription opioids in the last month.1
Drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people ages 15 and older, all races and ethnicities and across all levels of urbanization.2
Here at home, Illinois is also in the midst of this epidemic. In 2016, opioid-related overdoses claimed the lives of 1,946 Illinoisans, more than one and a half times the number of homicides and nearly twice the number of fatal car accidents. In response, state agencies began meeting to develop a comprehensive plan to address the crisis … and health care leaders like HSHS Medical Group are leading the fight.2
“This epidemic knows no boundaries and must be addressed with a sense of urgency to ensure vigilant prescribing and patient safety,” said Loren Hughes, MD, president, HSHS Medical Group. “An estimated one in three Illinoisans have been affected by the crisis, either suffering from opioid use disorder (OUD) themselves or knowing someone with OUD or someone who has overdosed.2 Through this policy and other initiatives, we are taking steps to address this throughout Central and Southern Illinois.”
Many Americans suffer from chronic pain. These patients deserve safe and effective pain management. Prescription opioids can help manage some types of pain in the short-term. However, there isn’t enough information about the benefits of opioids long-term. We know that there are serious risks of opioid use disorder and overdose—particularly with high dosages and long-term use.1
Opioids are a class of drugs that include heroin, common prescription pain relievers such as oxycodone and hydrocodone, and synthetically manufactured analogues such as fentanyl. Prescription opioids are important pain medications that can provide much-needed relief for patients with acute and chronic pain. However, physical tolerance to opioids can develop in as few as two to three days of continuous use, increasing an individual’s risk of developing opioid use disorder (OUD) and suffering an overdose.2
Dr. Hughes explains, “The medical group’s policy is now updated to national standards and is much more inclusive and comprehensive. We have adopted the CDC’s recommended best practices and evidence-based standards.
Dr. Hughes says that the purpose of the policy is for patients and providers alike. This includes:
To ensure safe prescribing and use of controlled substances, including long-term opioid therapy. These include opioids narcotics, stimulants and benzodiazepines. To ensure patients prescribed chronic controlled substances understand the health, dependency and diversion of risks of these medications.
To minimize potential risks for misuse and abuse of controlled substance medications.
To treat patients with the lowest possible dose of controlled substance medications.
To provide guidelines for regularly scheduled visits to review treatment goals for the patients receiving controlled substance medications.
To establish a standardized process for providing refills of controlled substances.
1CDC Guidelines for Prescribing Opioids for Chronic Pain
“The physician’s role is to educate the patient of the dangers and risks of taking long-term narcotics, the side effects and potential outcomes if you stop taking it—such as withdraw symptoms, which can be life threatening. It also sets the guidelines for patients, such as routine exams including a urine drug test,” states Dr. Hughes
The new policy also serves as a roadmap for advanced practice clinicians, such as nurse practitioners (NPs), physician assistants (PAs) and certified registered nurse anesthetists (CRNAs). In Illinois, these clinicians may have controlled medication prescription rights in collaboration with a physician.
A new patient-focused controlled substance agreement was also created by HSHS Medical Group to help manage expectations for patients and providers and works in tandem with the new policy. It serves as an understanding between the provider and patient and includes guidelines for patients to help them understand that the use of controlled substances, including chronic opioid medications, carries risk of harm or injury. Patients are required to review and sign the agreement.
“The benefits for patients and providers are significant, said Dr. Hughes. “For physicians it provides very clear guidelines and structure on how to treat these patients. For patients it allows those who have conditions that necessitate controlled substances as part of their care plan to address their pain and help them achieve an improved quality of life. Ultimately it allows us to take better care of patients and enhance the patient/physician relationship.”
In addition to the new policy and agreement, HSHS Medical Group is invested in several complimentary initiatives as well.
Dr. Hughes explains, “Several health care leaders along with HSHS Medical Group in Sangamon County, Illinois, have joined forces to establish what we call the SOS Team—short for the Springfield Opioid Summit. This includes medical groups, pharmacies, drug rehab centers, halfway houses, as well as the county health department and law enforcement opioid task force officers. We’ve had three meetings now and it’s been eye opening for us to learn how we are all approaching this problem and how together we can make a positive impact. Collectively our goal is to achieve consistency on how we do things as a medical community.”
Education plays a key role as well. The county government is providing materials such as patient cards and handouts, as well as manning hotline numbers where addicted patients can call for help, support and counseling. “We are also working on placing the NARCAN antidote where it needs to be, which is an emergency treatment of an opioid emergency, including an overdose. For example, police officers carrying NARCAN in their cars,” said Dr. Hughes
The medical group is working diligently to enhance the education portion of this solution, not only for patients, but for all of its offices and providers explaining what the alternatives are to using these medications. “We are also exploring alternative ways to treat patients who suffer with chronic pain including non-addictive pain medications, physical therapy and pain management. We are considering other modalities such as yoga, meditation, hypnosis and acupuncture. These have all been shown to play a role too,” said Dr. Hughes.
Dr. Hughes concludes, “Patients can be assured that by coming to us, reviewing our policy and following the guidelines, it will enhance their patient/physician relationship and their relationship with the office. Patients, families and the communities we serve can come to us with confidence for the safest best possible care.”
“Patient safety is a critical component of our patient-first care at HSHS Medical Group,” added Melinda Clark, chief executive officer of the medical group. “We are fully committed and taking positive steps to address the opioid crisis to strengthen and enhance the management of controlled substances for the health and safety of patients.”
2 State of Ill--Comprehensive Opioid Data Report-www.dph.illinois.gov/sites/default/files/publications/publicationsdoil-opioid-data-report.pdf
Number of Opioid Overdose Deaths by Quarter, Illinois, 2013-2017-Illinois Department of Public Health, Division of Vital Records.