Medication Safety Week (April 1-7) is a time to focus on the importance of ensuring that prescription drugs are administered appropriately and that patients and communities are protected from the dangers of drug abuse.
Although many types of prescription drugs are overused or abused, there is currently a growing, deadly epidemic of unintentional prescription painkiller overdoses and death. According to the Centers for Disease Control and Prevention, nearly three out of four prescription drug overdoses are caused by prescription painkillers — also called opioid pain relievers.
The use of opioids for the treatment of chronic non-cancer pain has escalated over the last decade, making opioid medications some of the most commonly prescribed medications in the United States. While treatment with opioids is appropriate for some people with chronic pain, there is significant evidence that opioids have been over-prescribed among the general population, leading to adverse consequences.
Kaiser Permanente has been focused on this issue for several years and continues to build upon and spread successful practices. The Safe and Appropriate Opioid Prescribing Program aims to reduce overprescribing, overuse and abuse, and to reduce the volume of dangerous drugs being diverted into communities. The program primarily targets members who are receiving chronic opioids, are 18 years and older and do not have cancer.
“Opioid over-use and abuse is a public health epidemic,” said Michael Kanter, MD, director of quality and clinical analysis for the Southern California Permanente Medical Group. “It’s not just about cutting dosages of drugs. It’s about having a program that will benefit the patient, and provide relief of pain without putting the patient at risk for complications of opioid overuse. It requires many professionals in different specialties providing input.”
Key elements include:
- Prescribing generic drugs when available (as brand drugs are more likely to be diverted into the community)
- Reducing the prescribing of large quantities and high doses of opioids
- Reducing overlapping opioid prescriptions, improving quality of care with regular and timely office visits
- Improving care coordination among specialties
The program, launched in Southern California, has demonstrated significant reduction in the prescribing of opioid medications that pose the highest risk for abuse and diversion into the community. Over a three year period, the number of high-volume opioid-containing prescriptions for non-cancer, non-hospice patients decreased by 91 percent and the net number of brand name opioids dispensed when generics are available dropped by 95 percent.
Kaiser Permanente has built upon the successful efforts pioneered in Southern California to incorporate additional elements such as re-educating physicians regarding safe and appropriate opioid prescribing and enhancing the role of pharmacists in identifying and addressing possibly inappropriate opioid prescribing. The organization has also participated in efforts led by public health departments in several California counties aimed at adopting standardized treatment and opioid prescribing practices for emergency departments.
“The success we’ve had demonstrates that we can systematically reduce inappropriate overprescribing and reduce the risks of overdose, misuse, abuse and diversion, not only in our membership, but within the community, and we can do this while improving pain management,” said Joel Hyatt, MD, lead for Community Health Improvement and emeritus assistant regional medical director for Southern California Permanente Medical Group.