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Community effort aims to curb opioid overdose, misuse

A collaborative effort led by Intermountain Healthcare is resulting in changes in prescribing practices, more access to treatment, and greater public awareness about opioid misuse and overdose.
A collaborative effort led by Intermountain Healthcare is resulting in changes in prescribing practices, more access to treatment, and greater public awareness about opioid misuse and overdose.
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SALT LAKE CITY — From the development of new prescription guidelines to promising preliminary outcomes for people in treatment, a new community effort is attempting to address Utah's high rate of prescription opioid overdose deaths and misuse.

"It's certainly a public health crisis across the nation and particularly in Utah, where we are fourth in the nation for prescription opioid overdose deaths," said Lisa Nichols, community benefit behavioral health director for Intermountain Healthcare, addressing Utah lawmakers recently.

"There's somebody dying in Utah nearly every day from an opioid-related death, and it surpasses other causes of death, including motor vehicle accidents, firearms, falls, etc.," she said.

There are no simple solutions to the problem, but the Opioid Community Collaborative is making headway on several fronts, Nichols told members of the Utah Legislature's Health and Human Services Interim Committee. The collaborative, housed at and primarily funded by Intermountain Healthcare, includes government, behavioral health treatment providers and law enforcement partners.

The group's charge is to "decrease the burden of pharmaceutical drug misuse, abuse and overdose" through provider education, public awareness and access to treatment.

"It's very clear to me that physicians play a central role in turning around this epidemic," said Dr. Michael Woodruff, an emergency room physician for Intermountain Healthcare, who also works on patient safety issues.

To that end, more than 1,500 physicians have participated in training regarding opioid prescribing to raise awareness about overprescribing, recommend alternatives to opioid prescription medication — such as over-the-counter medications and lifestyle changes — and giving providers "permission to prescribe less."

Guidelines under development for treating acute pain encourage providers to "avoid prescribing more than three days or 20 pills."

The average number of opioid tablets prescribed per order in Intermountain's primary care practices has decreased 10 percent since 2012, according to internal data shared with lawmakers.

Decreases in numbers of patients receiving prescriptions for opioid medications have also decreased among patients treated for sprained ankles in emergency rooms, as well as among women leaving hospitals after vaginal births.

Intermountain's recommended guidelines coincide with recommendations of U.S. Surgeon General Dr. Vivek H. Murthy, who in August sent a letter to 2.3 million American health professionals asking them to be part of an effort to turn the tide on the nation's opioid epidemic.

The letter notes that nearly two decades ago the medical community was encouraged to be more aggressive about treating pain. As numbers of prescriptions for opioid pain relievers increased, so have deaths from opioid overdose.

Under the surgeon general's Turn the Tide initiative, health care providers are also encouraged to screen patients for opioid use disorder and refer them to evidence-based treatment.

Nichols said Intermountain Healthcare, which has committed $3.5 million to the three-year initiative, has also installed prescription drop boxes at 21 community pharmacies. They have collected nearly 8,350 pounds of prescription medications. Use of the boxes increased to 35 percent of people surveyed by Intermountain in 2016 from 16 percent in 2011.

Treatment is a key pillar of the initiative, Woodruff said.

While emergency department staffs frequently encounter patients who are struggling with opioid-related substance use disorders, "probably every shift we have to turn them away because we can't refer them to a treatment program in the next couple of days because there simply aren't slots or they're unfunded," he said.

Demonstration projects are underway to provide treatment for some 200 people through demonstration projects at Davis Behavioral Health and Weber Human Services in Ogden primarily funded by Intermountain Healthcare.

Under the project, people can be placed in treatment within a matter of days, compared with the more common four- to six-month waits for behavioral health treatment, said Kristen Reisig, clinical director of Davis Behavioral Health.

Thus far, data indicate higher numbers of people have remained in treatment compared with conventional approaches, more are employed and most are stable in their housing.

People in the Opioid Community Collaborative, over the course of a year, "are growing in their abstinence, which is exactly what we want," Reisig said.

Moreover, people are sticking with their treatment programs, which likely is due to intensive outreach efforts on the part of treatment providers, she said.

"It’s not uncommon for people to be in treatment for three months and have a 64 percent retention rate, but to be at 12 months and have 79 percent of people still engaged in care is remarkable," Reisig said.

Committee co-chairman Rep. Kay McIff, R-Richfield, replied, "It's nice to get some good news for a change."

Considering the early successes of this approach, Reisig said demonstration projects need to be expanded elsewhere in Utah and within the public substance use and mental health system.