Opioid prescriptions down



LOCK HAVEN — In Central Pennsylvania, a region adversely affected by the opioid crisis, healthcare giant UPMC Susquehanna is cutting opioid and opiate prescriptions, educating staff and working with the community to better handle people suffering from addiction.

“Our physicians are dramatically reducing opioid usage among patients,” said Ron Reynolds, chief operating executive of UPMC Susquehanna Lock Haven.

Lycoming County was hit especially hard by the opioid crisis, citing 35 drug-related deaths in 2016 and over 38 in 2017. In June 2017, overdoses spiked due to the use of deadly fentanyl, and 51 occured over a 48-hour period in Lycoming County.

According to Alex Johnson, director of Addiction Medicine at UPMC Susquehanna Divine Providence in Williamsport, monthly opioid-related new prescriptions are down 34 percent. New morphine and morphine-related medication prescriptions are down by nearly half, compared with last year’s data.

And if you are a patient in any campus of UPMC Susquehanna’s emergency department, you’re limited to a three-day prescription for all controlled substances.

In fact, UPMC Susquehanna Lock Haven does not prescribe any opioids for pain management.

In March, UPMC Susquehanna formed an Addiction Medicine service line, allowing incoming patients to have access to addiction care consultations and medication-assisted treatment (MAT) options.

Within this department, UPMC practices the “warm handoff” initiative, in partnership with Williamsport-based West Branch Drug and Alcohol Abuse Commission, with the goal of “helping transition overdose patients quickly into treatment and connecting them with resources to reduce repeat overdoses,” said Johnson.

During the “warm handoff,” medical staff flag a patient with a substance use disorder (SUD) and call the 24/7 certified recovery specialist (CRS) line. The CRS, who is trained to speak with patients that have an SUD, performs a screening, brief intervention and referral to treatment, all while looping in the patient and the patient’s family on the situation.

Johnson said only a minority of addiction cases qualify for in-patient treatment at a hospital or other facility. In most cases, the CRS refers a patient to outpatient counseling, rehab or MAT services, like prescribing suboxone or buprenorphine to treat narcotic pain reliever addiction disorders.

Since the Addiction Medicine program was formed, there has been a dramatic increase in CRS and patient interactions. From October 2017 to March 2018, there were only 21 warm handoffs. But in April there were 26, and in May the number jumped to 61.

“This increase is not due to the fact that there are more (substance use disorder) patients,” said Johnson. “Those patients would have come to the hospital anyways. The reason there is an increase is because awareness has spread about the warm handoff service and the positive effect it is having.”

In the wake of increased drug-related overdoses and problems, UPMC Susquehanna added many training protocols for nurses, doctors and other medical staff.

Two of the UPMC family medicine physicians are continuously training and monitoring all of the providers in the management of chronic non-malignant pain, which is severe pain that is not progressive nor caused by a disease. For example, someone with lower back pain from a car accident years ago would be suffering from chronic non-malignant pain.

CNMP is one major prong of the opioid crisis, because overprescription of opioids to chronic pain sufferers led many people to get hooked on painkillers, and sometimes move to harder drugs like heroin.

UPMC Susquehanna has also implemented a “Visiting Professor” series.

“Every Friday morning, a providers gives a lecture on an area of their expertise. Clinicians are provided continuing medical education credits for attending. We have multiple lectures that educate the medical staff on opioid stewardship, addiction medicine, (and) chronic pain management,” said Johnson.

UPMC Susquehanna Williamsport has a Family Medicine Residency program, which specifically created curriculum around chronic non-malignant pain protocols, opioid prescribing and recognizing and treating addiction.

Johnson added, “Some of our medical staff are champions that represent the region for the PA Prescription Drug Monitoring Program.”

The PDMP collects information on all filled prescriptions for controlled substances, allowing health care providers to access a patient’s controlled substance prescription history. This lets providers know if a patient has an outstanding prescription or if there are any risks in prescribing controlled substances to that person. It also helps law enforcement detect and prevent the criminal diversion of controlled substances, fraud and drug abuse.

But there is still no solid tracking of overdoses. The PDMP has information on drug-related overdoses in emergency departments in each county by quarter, but acknowledges that the data may be incomplete because not all overdoses occur in emergency departments.

When asked if overdoses had increased, decreased or stayed the same, Johnson said, “It’s not just a simple yes or no answer. Monitoring overdoses is difficult for a variety of reasons. Data can be hard to capture because the patient’s main symptom may not be the overdose itself so it may not be captured. We are currently working on developing methods to track this.”


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