By Washington Health Alliance, Special for USDR
Two groups representing Washington state health care organizations issued a call to action today inviting health care leaders across the state to join a coordinated response to Washington state’s opioid epidemic. The Quality Improvement Committee of the Washington Health Alliance (Alliance) and The Dr. Robert Bree Collaborative are asking health care practitioners and leaders to stop the epidemic before it begins by reducing the number of people who ever start an opioid prescription.
The call to action recommends that providers use evidence-based prescribing practices for acute, short-term pain, asks health plans to use data to identify patterns of overprescribing and high utilization and encourages patients to ask questions and explore other treatment options when prescribed an opioid. Good pain care for serious injuries and illnesses is important, but the recommendations stress that it is better for everyone’s better health not to start opioids for mild to moderate pain care; and if one starts, to use short-acting doses for a few days at a time, and reassess frequently.
Drug overdose is the leading cause of accidental death in the US and in Washington state, and opioid addiction is driving the epidemic. In 2014 alone, more than 14,000 people died from overdoses involving prescription opioids (approximately 425 deaths in Washington state alone). In the first three months of 2016, at least 188 people died due to opioid overdose. The epidemic is growing, devastating Washington families and communities.
According to a report released by the Alliance last August, approximately 1 in 12 adults in Washington state received a prescription for an opioid during the period from July 2013 to June 2014. There was tremendous variation among regions and by age and gender. In some communities as many as one in six middle-aged women received an opioid prescription. Particularly troubling was the variation in rates for opioid prescriptions for children and adolescents. In the highest prescribing regions, approximately one in ten girls and one in thirteen boys ages 12–19 years received a prescription for an opioid in the reporting period. While opioids are effective in helping children and adolescents cope with moderate to severe pain, particularly pain associated with cancer treatments, the numbers suggest that prescriptions go far beyond the palliative care for a major, severe illness.
Call to action aims to reduce the number of people who start taking opioids
There are many factors driving the epidemic. Health care providers and health insurance plans can help reduce the number of people who start taking opioids and help those who may be at risk for addiction.
For health care systems, the call to action encourages providers to register and use the Washington State Prescription Monitoring Program. They also recommend using evidence-informed pain care and opioid prescribing practices, following CDC guidelines for short-term, acute pain.
Dr. Gary Franklin, neurologist and medical director for the Washington State Department of Labor & Industries, who raised alarm bells early on about the over-prescription of opioids, says, “Opioid medications are powerful and can be the right choice for treating severe acute pain, but only for a very short time. The CDC recommendation is that most acute pain situations in which opioids may be indicated should be limited to three or fewer days of prescription opioids. This would be crucial in teenagers, whose brains are still developing and are more susceptible to substance abuse.”
For health insurance plans, the call to action recommends including the use of evidence-based prescribing guidelines in provider contracting as a quality and safety goal. It also encourages health plans to use health data to identify individual patients who appear to be high utilizers and identify any patterns of potential overprescribing from clinicians.
“Everyone needs to help turn back the opioid epidemic,” says Dr. Dan Kent, Chief Medical Officer for UnitedHealthCare and incoming chair of the Washington Health Alliance’s Quality Improvement Committee. “Health plans do a lot of work to improve quality; many are helping the Alliance and the Bree Collaborative with this call to action. We should support the new prescribing guidelines from CDC and Washington State. They recommend much more careful prescribing of first opioid prescriptions. We encourage providers to review their own prescribing and acute pain care practices. Let’s be sure we are not starting the next wave of opioid addiction.”
- Call to action for health care systems
- Call to action for health insurance plans
- Opioid Prescribing Guidelines for Providers (fact sheet)
- Opioid Medication & Pain: What You Need to Know (fact sheet)
- Alliance report highlighting opioid prescribing patterns in Washington state
About the Washington Health Alliance
The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 185 member organizations. A cornerstone of the Alliance’s work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality.
About The Bree Collaborative
The Dr. Robert Bree Collaborative was established in 2011 by the Washington state Legislature to give public and private health care stakeholders the opportunity to identify specific ways to improve health care quality, outcomes, and affordability in Washington State. These stakeholders are appointed by the Governor as Collaborative members and represent public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. Each year, our members identify health care services with high variation in the way that care is delivered, that are frequently used but do not lead to better care or patient health, or that have patient safety issues. For most topics, we form an expert workgroup to develop evidence-based recommendations. Recommendations take into account existing quality improvement programs and the work done by other organizations and are then sent to the Washington State Health Care Authority to guide the type of health care provided to Medicaid enrollees, state employees, and other groups.
SOURCE Washington Health Alliance