This article is more than 5 years old. Information may no longer be current.
Protocols at Cleveland Clinic aim to reduce opioid prescriptions in Ohio
Click Here to Manage Email Alerts
With Ohio ranked as having one of the highest opioid-involved overdose death rates by the National Institute on Drug Abuse, Cleveland Clinic began making changes through pharmacy, prescribing and company-wide programs to reduce opioid prescribing after surgery.
According to Brendan M. Patterson, MD, chair of the department of orthopedic surgery at Cleveland Clinic, different opioid prescribing protocols have been modeled after state regulations depending on the area of medicine. The protocol implemented in the department of orthopedic surgery at Cleveland Clinic includes limiting the number of pills that can be written for any prescription, which has been reduced to 28 tablets.
To reduce number of opioids prescribed per surgery, Patterson noted surgeons use nerve blocks and other non-opioid pain medications, such as acetaminophen, ketorolac and gabapentin, during and after surgery. Providers are also advised on their prescribing patterns in relation to one another, and there are plans to give providers quarterly reports on their prescribing patterns. Patterson believes these metrics should be transparent and used as a way to provide feedback.
“Many providers do not know what their pattern of prescriptions are relative to their colleagues and, in that way, systems can identify best practice for managing pain in any discipline if they are comparing internally and externally with peers,” Patterson, professor of orthopedic surgery at Case Western Reserve University, told Healio.com/Orthopedics.
Educate providers, community
Faculty and residents at Cleveland Clinic receive education on the physiology of opioid use, the risks of addiction and what can be done for reducing a patient’s opioid requirement through three web-based modules, according to Patterson. He added Cleveland Clinic has a number of educational programs on the dangers of opioid and subsequent drug use for high schools and grade schools in the region.
“We also share some of our data with the Ohio Hospital Association so that our approaches, our prescribing patterns can be aggregated with other major health systems so we can develop a public health perspective at the state level as to what is happening with regard to opioid use in the state of Ohio,” Patterson said.
Reduce opioid prescriptions
One challenge, according to Patterson, is treating patients with arthritis who have been managing their pain with opioids.
“Those patients can have a difficult course following surgery,” Patterson said.
With the help of a pain management specialist, Patterson noted they have a program to wean patients off opioids either to a lower level of requirement or completely. This protocol includes providing the patient with additional coping skills in combination with substituting gabapentin or a nonsteroidal medication for the opioid medication.
“Cold turkey would send ... many patients into withdrawal, so the gradual reduction in opioids is the preferred method,” he said.
Although the goal is to reduce the number of opioids prescribed to patients, Patterson noted that the number cannot be zero as opioids can be “important in helping people get through care for complex orthopedic surgeries.”
“Treatment can be very, very painful and we should not deny [patients] some of the help that will make their course easier and hopefully avoid some of the problems that come with longer-term use,” he said. – by Casey Tingle
References:
newsroom.clevelandclinic.org/2017/11/03/how-cleveland-clinic-is-dealing-with-the-opioid-epidemic/
www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state
Disclosure: Patterson reports no relevant financial disclosures.