POINT OF VIEW: Reduce the health care system’s dependence on opioids


There is good news to report in the battle to fight the opioid epidemic, and it’s coming from the people whose job it is to treat pain. We’re seeing the beginnings of a national, strategic approach from health care providers to rethink how pain is treated, supported by a variety of promising regional and local initiatives.

There isn’t a moment to waste. The latest annual National Survey on Drug Use and Health (NSDUH) estimates that 11.5 million people over the age of 12 misused prescription pain relievers in 2016. States such as Florida and Ohio are among the hardest-hit areas. In Florida, deaths last year attributed to opioid abuse were up approximately 37 percent from 2015. Palm Beach and Broward counties lead the state in drug overdose deaths.

Ohio’s governor made news recently by establishing acute pain prescribing limits. The limits allow health professionals to prescribe painkillers for acute pain only up to seven days for adults and five days for kids and teens, with several exceptions. Florida’s governor has proposed even more restrictive measures.

Cleveland Clinic Florida has adopted a Controlled Substances/Prescription Drug Monitoring Program (PDMP) Policy, which adheres to the Florida Department of Health’s defined standards of practice for prescribing, administering and dispensing controlled substances. Among other things, this policy requires a discussion about the risks and benefits of controlled substances with patients, a written agreement with patients if a controlled substance is prescribed for chronic pain, and regular follow up appointments at least every three months to address the efficacy and appropriateness of treatment.

At the national level, the Joint Commission, which accredits and certifies nearly 21,000 U.S. health care organizations and programs, released new pain assessment and management standards for accredited hospitals that will take effect Jan. 1. These standards require hospitals to offer alternative pain treatment methods, such as acupuncture, chiropractic, physical and cognitive behavioral therapies. Earlier this year, the U.S. Centers for Disease Control and Prevention weighed in, issuing new clinical practice guidelines on the appropriate use of opioid therapy for pain management.

These national efforts will no doubt fuel further adoption of regional and local pain management strategies.

Using nonaddictive painkilling techniques for injury and post-surgical pain management is another approach. In one clinical trial, Cleveland Clinic Florida orthopedic surgeons are comparing ultrasound-guided injections of analgesia to specific nerves versus a slow-release pain pump approach.

Ultimately, changing prescriber habits is vital for patient safety. Working together at the national and local level, we are poised to make a real difference in fighting this insidious epidemic.

OSMEL DELGADO, WESTON

Editor’s note: Osmel Delgado is chief operating officer with Cleveland Clinic Florida.



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