Utah County’s Use Only as Directed campaign is seeing good results.
Intermountain Healthcare and MountainStar Healthcare have each seen double digit decreases in the percentage of opioids prescribed at their hospitals, according to the organizations.
“We think there has been success,” said Lisa Nichols, the assistant vice president of community health for Intermountain Healthcare. “There is still a lot to be done, and we have to continue to monitor it.”
The Use Only as Directed campaign has been running at the statewide level for several years. In 2018, Utah County’s Intermountain Healthcare and MountainStar Healthcare hospitals banded together to implement a localized version of the Use Only as Directed campaign with the goals of decreasing the number of opioids prescribed to patients and educating the public about opioid addiction.
The hospitals have posted messages with questions patients should ask their doctors and have taken several measures to reduce opioid prescriptions.
Utah had a rate of 15.5 drug opioid deaths per 100,000 people in 2017, compared to a national rate of 14.6, according to information from the National Institute on Drug Abuse. That same year, Utah providers wrote 63.8 opioid prescriptions for every 100 persons, compared to the national average of 58.7 prescriptions.
A physical dependence on opioids can happen in a week, according to materials presented at the countywide Use Only as Directed launch in 2018. The risk of opioid abuse increases by 20% for every week a patient stays on the medication.
Intermountain Healthcare discovered in surveys that patients were frequently using less than half of the opioids they were prescribed.
“Medical providers are in this tough place, because they don’t want people to be in extraordinary pain, but they also want to keep people safe,” Nichols said.
Intermountain Healthcare began working at a system wide level in 2015 to lower Utah’s opioid overdoses. Nichols said Utah had traditionally been in the top ten nationally for opioid deaths and has since dropped to being in the low 20s in rankings.
“It is clear it is a significant health issue in our community,” Nichols said.
Intermountain launched an opioid community collaborative, which has shared solutions about opioid abuse.
“We want a very comprehensive and collaborative approach,” she said. “This concern is bigger than Intermountain Healthcare.”
It has also installed medication disposal drop boxes in each of its clinics and has worked to educate caregivers about the potential dangers of opioids.
Intermountain Healthcare’s survey results found that more than 80% of Utahns dispose of their medications. More than 36,000 lbs of medications have been dropped in Intermountain’s 23 community pharmacy drop boxes since Feb. 2015.
Nichols said the community is becoming more aware of the dangers of keeping unused opioids around, such as children and adolescents who aren’t prescribed them taking the medications.
The organization has found that three days worth of opioids for many patients is sufficient.
It’s reduced the number of opioids prescribed for acute pain by 35% across its system, which has led to a 6.5 million fewer tablets being prescribed from 2017 to 2019. Its goal is to decrease that amount by 40%.
Nichols said that while Intermountain Healthcare is unable to track how many people have an addiction to opioids, the system is seeing overdose numbers decrease. She said it is focused on preventing addictions from forming in order to decrease the amount of deaths caused by overdoses.
The system is working on getting treatment for addictions started while an overdose patient is in an emergency department instead of having them wait three to six weeks for an appointment. It is also looking to create opioid-free surgery centers.
Nichols said she wants patients to speak to their medical providers about opioids and say if they’re at risk or don’t want a prescription.
Utah County’s other hospitals have also seen progress under the campaign. Timpanogos Regional Hospital in Orem and Mountain View Hospital in Payson have both adopted an opioid reduction plan called Alternatives to Opioids in the Emergency Room, or ALTO in the ER. Timpanogos Regional Hospital has reduced opioid prescriptions in ER by 18% and Mountain View Hospital has reduced them by 12%, according to Nate Black, a spokesman for both hospitals. Overall, about 15% of ER patients receive an opioid prescription.
An enhanced surgical recovery initiative has led to a 50.4% decrease in opioid use following major surgeries during 2018 and 2019 across HCA Healthcare hospitals, which is the umbrella company for MountainStar Healthcare, which operates both Timpanogos Regional Hospital and Mountain View Hospital.
“We have had a huge decrease in opioid use,” Black said.
Black said the hospitals are prescribing alternative medications, such as ketamine or lidocaine, that Timpanogos Regional Hospital is using AccendoWave electroencephalography technology to ease pain, and that both hospitals have capped off opioid prescriptions to five days worth of medication.
The hospitals also anticipate that electronic prescribing of opioids will be online by the end of their first quarters this year. Black said the new system will make the prescription process more secure by ending the use of paper prescription pads.
Black said overdose deaths often come from people who have access to unused and leftover opioids from friends and family members. The hospitals are working to educate patients about why they shouldn’t share or hold on to unused medications.
It’s added a prescription drop box for unused medications at Mountain View Hospital. Black said that the Payson hospital sees more drug-seeking behavior than the northern end of the county.
“That is a hot spot that has been identified by the county Health Department, and so I think that we are having a major impact on that area just by the fact that we aren’t prescribing as much,” Black said.
As work continues into 2020, Black said it’s an issue the hospitals are working on.
“It is something that we are constantly reminded of, this need to make sure that we are making sure we are not contributing to the problem, but that we are actively and proactively resolving it,” he said.