Tags: patient safety , redesigning care , research and discovery

In 2016, 8 in 12 Massachusetts residents who died from an opioid overdose had been prescribed opioids in the period leading up to their death. It’s uncomfortable to admit, but the data proves it: health care is a big part of the country’s opioid epidemic.

But we will also be a part of the solution, which is why experts throughout the Partners HealthCare network dedicate themselves to the extraordinary steps necessary to fight this devastating disease.

One expert, Sarah Wakeman, MD, who chairs the Massachusetts General Hospital’s Opioid Task Force alongside colleague Jeff Ecker, MD, chief of OB/GYN at MGH, has been at the forefront with an ambitious research and policymaking effort that’s seen success even beyond the walls of her hospital.

During the second annual Partners Quality & Safety Symposium, Dr. Wakeman detailed the efforts that have had an impact on the way we talk about, treat, and support patients who are battling opioid addiction. For her, the discussion regarding opioid prescription reform begins with using a “person first” way of speak about addiction and those who suffer from the disease, just as we do with those living with conditions such as schizophrenia or diabetes.

“As health care providers, the language we use is incredibly important. As we change our language to avoid terms like ‘abuse’ and ‘addict,’ we should be talking about addiction as an illness and not a moral failing. We should not be using the term ‘abuse,’ which actually means a willful act of misconduct. Think about other things that we call abuse, like child abuse and sexual assault—none of these things are medical diseases,” she said.

In 2016, 8 in 12 Massachusetts residents who died from an opioid overdose had been prescribed opioids in the period leading up to their death.

It may sound “PC,” Dr. Wakeman acknowledged, but the data is also clear in this area as well.

“Studies have shown that when randomize health care providers, and have them read patient vignettes where they are described as ‘substance abuser’ or ‘person with substance use order,’ you discover that master’s degree level therapists are more likely to recommend punishment for an abuser, than person described as a person with substance use disorder,” she said.

Related story: "Zero stigmas, deaths" - See how Massachusetts leaders, including Partners HealthCare, will RIZE up to battle opioid addiction.

Beyond words, there are also actions happening at MGH that have changed the way the hospital addresses the epidemic. To further codify MGH’s approach to opioids, for example, the MGH Opioid Task has been integral to crafting multidisciplinary guidelines that help prescribers effectively manage acute malignant and chronic non-malignant pain.

“This is an issue that touches every department in very different ways, Dr. Wakeman said, so it’s been important to get input from all areas to determine what made sense for the patient population and prescribers alike,” Dr. Wakeman said.

Most importantly, with better education came changes in prescribing behavior [...] Pills per prescription went down by 5 pills, and the number of days an individual was directed to take a medication went down by 1.5.

The task force has been a key driver behind various education and incentive programs throughout MGH, including a training program, supported by collaborative health care workforce management software from Healthstream, which was able to push out and assign opioid guideline education to 4,400 staff, doctors, physicians and other paid practitioners.

“Our goal was to empower clinicians to prescribe safely and responsibly; to help them treat pain, but be thoughtful in approach; and also to educate about recent legislative changes. Many prescribers were not aware that legislation had changes and could have faced the possibility that they may be practicing in way that breaks the law. Then, obviously, we must improve care for patients and those with opioid disuse disorder,” Dr. Wakeman said.

The training has enjoyed positive results, with 99% of participants meeting learning objectives and 63% saying that they’d change their practice because they felt informed, better understood the legislative requirements, and supported by services available through Partners eCare. One participant even made the change to co-prescribe, which means they would prescribe Naloxone with chronic opioid treatment medication.

Most importantly, with better education came changes in prescribing behavior. 

With the training in place, MGH saw a decrease across total opioid prescription claims, total pills per prescription, and the total number of days supplied per prescription. Pills per prescription went down by 5 pills, and the number of days an individual was directed to take a medication went down by 1.5.

Dr. Wakeman and her colleagues are bolstered by the results, even as they acknowledge there’s substantial work to be done: “One challenge we all face with pain management is that no one knows what the ‘right’ number is. The nuance in the work we’re doing is to discover where that sweet spot is; the spot where we’re still adequately treating pain, but we’re not becoming opioid-phobic, because that's when you hear these horrible stories of people with legitimate chronic pain who are committing suicide because they can’t find treatment. I can’t tell you what the right number of claims is, or the right number of pills is, but I think we can all say increasing these numbers probably isn’t good. The trend toward decreasing these numbers is what’s important.”