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blog_banner_Addressing-the-culture-of-overprescription

RESEARCH PREVIEW: Addressing the culture of overprescription

The issue of opioid use is fraught with questions about patient choice and provider responsibility. Do patients cling to excess pills or responsibly dispose of them? Is there a difference in when non-chronic users discontinue use of prescription pain medication versus chronic users (patients who’ve taken a prescription opioid in the past and are at higher risk of developing an addiction)? What about the role of prescribing doctors — what responsibility do they have to ensure narcotic pain medications are used properly and don’t fall into the wrong hands?

In a culture of overprescription of pain management medications, these are not idle questions. More than 50% of patients use less than five pills post-surgery, but the average prescription quantity is 30 pills. What, then, does real-life data show about patient usage and disposal?

A new window into patient habits and behaviors

Through a first-of-its-kind study, GetWellNetwork is helping researchers from Northwestern Medicine look at the daily habits and behaviors of surgical patients prescribed an opioid for acute pain management. The standardized and clinically meaningful patient-reported data amassed using GetWell Loop™ could help narrow in on and address some of the root issues that have led to the opioid epidemic in the U.S., including overprescription by physicians and opioid misuse by patients and others.

Backed by the American College of Surgeons, the study entails surveying patients before and up to 90 days following a surgical procedure. Researchers are tracking duration of prescription use and quantity of initial prescription versus total excess pills once no longer necessary for pain management and disposal methods if any.

This new research opens a window into how patients manage their pain, offering insight to physicians in a way that no one has looked at prior to this study. Collecting and reporting on patient-reported information, specifically, provides a prime opportunity for physicians to learn how to better anticipate and meet their patients’ pain control needs while reducing overprescription.

How did this study originate?

Though several evidence-based best practices exist for managing post-surgical pain while reducing opioid prescribing, they’re significantly underutilized by surgeons across the country.

“Surgical providers write nearly 10% of all opioid prescriptions and approximately 80% of the pills of those 28.3 million prescriptions go unused, leaving a staggering number of pills available for diversion and leaving them vulnerable to abuse or misuse,” said Jonah Stulberg, M.D., Ph.D., MPH, FACS, a general surgeon at Northwestern Memorial Hospital who is leading Northwestern Medicine’s opioid reduction strategies.

DIVERSION PREVENTION

Dr. Stulberg’s interest in diversion prevention when it comes to addictive pain medications led to the study that began last year. Diversion — when a legally prescribed controlled substance is given to another person for whom it wasn’t originally prescribed — is how prescription drugs are obtained by 70% of nonmedical users.

Seeking assistance with standardizing and collecting survey data in connection with his passion project — a study on opiate utilization — Dr. Stulberg initiated the clinical collaboration with HealthLoop (acquired by GetWellNetwork in November 2018). GetWell Loop (formerly HealthLoop) provides the mechanism through which patients are surveyed before and up to 90 days after a procedure to understand how they actually take prescribed opioids, and if, and how, they dispose of any excess pills.

"GetWell Loop is a way to gather clinically meaningful data in a standardized way, and to integrate real-time information into clinical engagement to improve patient care,” said Dr. Stulberg. “In the case of the opiate study, we are obtaining real-time insight into how patients are managing their pain, helping to inform treatment and prevent the misuse of narcotic pain medication."

Specifically, researchers are tracking data points such as:

  • How does the patient rate their pain pre- and post-procedure?
  • How many pills are they taking?
  • Is the patient a chronic user (i.e., do they have a history of taking prescribed opiates?)?
  • What are they doing with any excess pills (i.e., when the system determines they've finished usage before taking all pills)?

Ultimately, Dr. Stulberg hopes to minimize the risks of a surplus of unused opioids by developing “a sustainable model for safe opioid prescribing and optimal pain control” that can be scaled by hospitals and providers around the country. With funding through the National Institute of Health and the National Institute on Drug Abuse, he's overseeing a system-wide effort at Northwestern Medicine to change surgeons’ prescribing habits by implementing safer, more effective pain management strategies that minimize excess opioids and limit drug misuse.

Initial observations show interesting trends

The 18-month benchmarking study began last June at seven different health systems and is scheduled to conclude at the end of this year. Participating clients were given the option to embed the survey questions into their own “loops” (workflows), subsequently allowing them to gather their own unique datasets. As of April 2019, researchers have collected responses from about 1500 respondents. By the study’s conclusion in December, they hope to double that count.

OVERCONSUMPTION

Preliminary data shows that pain and pill quantity generally taper together over time, an ideal outcome. However, though their pain-level rating may be the same as those reported by non-chronic opioid users, results do show a significant number of chronic users extend their usage with many continuing to take medications for as long as a month to two months post-procedure.

This is an especially important behavior to tease out because a 2016 study found that 63% of high-dose opioid patients were still on a high dose 31-to-90 days after overdosing, and 17% of high-dose patients overdosed again within two years.

PILL SAVERS

Early data also shows that of those patients who’ve completed the survey, 50% don’t intend to dispose of excess pills and 22% aren’t sure how to properly dispose of unused pain medications. This aligns with the results of a recent national survey by GetWellNetwork of 1,000 consumers that indicated a gap in patient education on prescription opioids. Nearly half of the respondents (48%) reported not knowing how to properly dispose of leftover pain medications.

“For surgeons, opioids are an important tool for managing our patients’ pain, but if we prescribe these medications then we must also take responsibility for ensuring excess pills can be safely disposed of and taken out of the community,” said Dr. Stulberg.

A full report on the opioid utilization study will be published in early 2020. In the meantime, learn more about how the healthcare community can better educate patients in our recent webinar available for download in our on-demand library.