Toward a Better Approach to Opioid Use

Experts at Johns Hopkins Pain Symposium see a way forward.

Published in Dome - November/December 2017

More than half of the people who misuse narcotics get them from family or friends, says Peter Pronovost, director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

Prescriptions are often written for more pills than necessary, and patients are encouraged to accept these quantities so that they won’t have to pay for refills.

Anesthesiologist and pain medicine physician Mark Bicket has found that 74 percent of surgery patients don’t use all their pain medication, yet only 9 percent properly dispose of the excess. They sell or give away their leftover pills, or leave them in medicine cabinets, where they can be taken at a later time by family members, visitors or even children exploring in the house.

Such situations can turn deadly. Last year, prescription opiates were blamed for nearly a quarter of Maryland’s 1,856 opioid deaths.

Pronovost and Bicket spoke at the recent Johns Hopkins Pain Symposium, a daylong event aimed at changing a health care culture that gives hospital patients too many narcotics to manage their pain, then discharges them with too little information about what to do with any unused medication.

The symposium, organized by the Armstrong Institute and the Johns Hopkins Hospital Pain Management Committee, was held September 25 in the Chevy Chase Auditorium of The Johns Hopkins Hospital and featured experts from Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health.

Strategies that were discussed at the symposium include a greater push to non-narcotic therapies such as acetaminophen or physical therapy; electronic, standardized prescribing to ensure optimal dosing; and better instructions to patients about how to dispose of unused pills.

There’s much room for improvement. For every 100 opioid prescriptions that a doctor writes, only five go to patients who have exhausted all non-narcotic pain management options, says Pronovost, a practicing critical care physician and Johns Hopkins Medicine’s
senior vice president for patient safety and quality.

He adds that the medical profession needs to build systems that prevent the misuse of opioid prescriptions. Johns Hopkins has already begun: The health system is creating a “clinical community” to improve opioid management throughout a patient’s care experience. It is led by Peter Hill, senior vice president of medical affairs; and Daniel Ashby, vice president for pharmacy services.

The clinical community concept, developed at Johns Hopkins in 2011, brings together representatives from across Johns Hopkins Medicine, including patients and families, to develop a holistic approach to a particular disease or problem.

Other changes are coming from outside The Johns Hopkins Hospital. The federal Centers for Medicare & Medicaid Services, for example, is changing its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions, effective Jan. 1, to ask patients to rate how the hospital communicated about pain, instead of rating how it managed pain.  

Lt. Gov. Boyd Rutherford, the afternoon keynote speaker, is leading a statewide heroin task force that has increased the number of treatment beds in Maryland and ramped up public service announcements and education about the risks of opioid misuse through the “Before It’s Too Late” campaign.

“It will take the work of all of us, working with our federal partners, to address this challenge,” he says. “It’s really about saving lives and bringing more people into productive use in our society.”