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Providers at NYU Langone Health work to combat opioid epidemic
NYU Langone Health brings together health care providers at the institution to work as a team to create individual protocols for different specialties to combat the opioid epidemic.
“An institution has to both philosophically and financially dedicate the resources to assemble an opioid management team, include pharm D and anesthesiologists, internists, pain management folks and surgeons to come up with individual protocols for different types of surgery,” Joseph A. Bosco, MD, professor and vice chair for clinical affairs in the department of orthopedic surgery at NYU Langone Health, told Healio.com/Orthopedics. “This is a full team approach that requires multiple types of health care providers from surgeons, internists, pharmacists, pain management specialists, anesthesiologists [and] nurses, in order to do this.”
Team effort
Bosco said about 1 year and a half ago, each specialty set out to establish individual multimodal pain management protocols for the type of surgeries they perform.
“It requires commitment from the entire institution,” he said. “We worked with our anesthesia counterpart, our pain management counterparts, our PharmD pharmacists, as well as the clinicians, in order to develop a protocol where we basically in some cases eliminated and [in] most cases reduced by 85% the morphine equivalents patients were getting postoperatively.”
He said it is important for surgeons to explain to patients that they should expect pain and discomfort with orthopedic surgery.
NYU Langone Health uses an antibiotic stewardship program in which a group of health care providers determines the appropriate dose and proper type of antibiotics to use. Its multimodal approach includes the use of acetaminophen, NSAIDs, antidepressants, gabapentin, ice and local anesthetic periarticular blocks in which medications are injected in or around the joint after surgery.
“We are always in the process of becoming,” Bosco said. “Multimodal medication sounds great, but sometimes different medications can have side effects ... I think there are still a few outliers, and we are still frankly having issues or challenges with patients [coming] opioid dependent.”
He said 30% of patients who see an orthopedic surgeon for a musculoskeletal condition are on opioids prior to surgery, and 85% of those opioids were not prescribed by an orthopedic surgeon. Bosco said NYU Langone Health has hired more pain management specialists to help patients understand how to get off their opioids.
New opioid research center
NYU Langone Health recently launched the Center for Opioid Epidemiology and Policy, spearheaded by Magdalena Cerdá, DrPH, associate professor in the department of population health at NYU Langone Health.
“We decided to launch this center because of the problem that are facing right now in the country with drug doses, largely due to opioids,” Cerdá told Healio.com/Orthopedics. “We thought that one of the important contributions that as a university we could make was to bring data to the problem.”
She said research at the center focuses on the opioid epidemic and its evolution, where the problem is most concentrated, how to prevent it and to identify the types of policies that are most effective to address the opioid crisis. Cerdá said the center collaborates with clinicians on research about prescribing practices with the hope that it will change how opioids are prescribed at the institution.
“Our North Star is to try to address the opioid epidemic,” Cerdá said. “The hope is that by doing the research we’re doing we will be able to help identify effective solutions to the problem ... If we can do that, I think we can have a chance of making an impact in terms of addressing this epidemic, and hopefully new, emerging drug overdose problems, as well.”
She added, “The important role that a center can play is bringing people from different disciplines together to look at the problem from many different perspectives. That’s what we are bringing together experts from medicine, from epidemiology, from economics [and] sociology to look at this problem from many different lenses to try to figure what are the most effective ways to address it.” – by Monica Jaramillo
Disclosures: Bosco and Cerdá report no relevant financial disclosures.