By prescribing fewer opioids, doctors hope to slow addiction epidemic

It's impossible to talk about the opioid epidemic without talking about doctors.

More and more physicians are owning up to the role they played in prescribing highly addictive painkillers, peddled by drug companies as safe, to millions of Americans — eventually leaving some with a raging addiction.

And when heroin costs $5 a bag, the transition from prescribed pills to a white, powdery street drug becomes a lot easier.

The epidemic is one that officials from nearly every sector are trying to fight, as a public health crisis claiming more lives than the Vietnam War ever did continues to strip agencies of millions of dollars.

Last week, Michigan doctors fighting to change prescribing habits shared some of their success stories with physicians at Christiana Care Health System. Here were some of the highlights – and what Christiana is already doing to help.

Opioid prescriptions still flowing from dentists

Nearly 80 percent of people aged 13 to 30 were prescribed an opioid when they had their wisdom teeth removed, according to a study that examined dentistry data from July 2009 to December 2015.

This prescription increased the likelihood of a person becoming addicted to those drugs 3½ times more than a person never exposed to opioids, said Dr. Chad Brummett. He's an associate professor with the University of Michigan Medical School and co-director of the Michigan Opioid Prescribing Engagement Network. 

And dentists continue to prescribe high numbers of opioids, especially when it comes to oral surgery, Brummett said. 

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Opioids don't equal patient satisfaction

Contrary to popular belief, Brummett said the amount of opioids prescribed after surgery is not associated with patient satisfaction or prescription refill rate.

In fact, studies show that the less opioids patients are prescribed, the less they will end up taking – which Brummett hopes will encourage doctors to prescribe less in the first place.

"I don't usually start my day with a chocolate croissant, but if you put it out there, I might eat it," Brummett said, acknowledging that putting more opioids into the hands of patients only ups the availability to the average person.

The state of Michigan is also working with insurance providers to create monetary incentives for prescribing less or no opioids at all after specific procedures. Delaware currently does not offer those incentives.

Less exposure to opioids is better for the entire society, Brummett said.

"We really need to think about keeping healthy people healthy," he said.

What Christiana Care is doing

Dr. Matt Powell, an anesthesiologist at Christiana Care who is leading Delaware's version of the Opioid Prescribing Engagement Network, said physicians in Delaware – and nationwide – know they're over-prescribing, but need guidance on how to successfully change those habits.

"We're spending all the money on treatment," he said, "but we have to cut off the supply."

In 2012, Delaware led the nation as the No. 1 prescriber of high-dose opioids. Now, the state is losing about one person a day to suspected drug overdoses. The two situations share a link that Christiana Care wants to help prevent.

From July 2017 to July 2018, the hospital reported a 40 percent reduction in opioids prescribed to patients, which Christiana Care attributes to surgical procedures. The hospital system says this is a direct result of new guidelines created by Delaware OPEN.

Christiana Care also reported:

• A 40 percent reduction in the number of opioids prescribed after some ob-gyn and general surgery procedures.
• A reduction by almost 50 percent in the rate of opioid prescriptions among discharged emergency department patients.
• A 37 percent reduction in the number of primary care patients on chronic opioid therapy for pain in a pilot project at the Rocco A. Abessinio Family Wilmington Health Center at Wilmington Hospital.

Powell said the results show that prescribing fewer opioids is possible – and so is the mindset shift that comes with it.

"We need to prescribe for just enough rather than just in case," Powell said.

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Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.