Anesthesiologists: better prescribing = safer care, less addiction

Jul 26 2017

Anesthesiologists: better prescribing = safer care, less addiction

An anesthesiologists’ group is partnering with a health care quality improvement firm to address one of the primary causes of the opiate epidemic: the over-prescribing of pain medications.

The American Society of Anesthesiologists (ASA) is working with Premier Inc., a health care improvement company that works with about 3,750 U.S. hospitals, on a project to improve post-operative pain management. The pilot project, scheduled to launch in September and run through March, 2018, is intended to reduce patient harm from opioid misuse, dependence and addiction.

Premier has chosen 30 high-performing hospitals to participate. It is launching the pilot through its Hospital Improvement Innovation Network, which is part of the Centers for Medicaid & Medicare Services Partnership for Patients program.

ASA President Alexander Hannenberg, M.D., says acute pain from surgery, injuries, and chronic back pain “are all situations in which narcotics are used, probably less strategically and in greater quantities than necessary. A lot of those narcotics are prescribed by a primary care physician.” Hannenberg told The Influence he is “pretty confident” over-prescribing is an issue that can be effectively addressed through better education.

The ASA has been working for at least two decades on alternatives to narcotics for managing acute pain. Hannenberg says the ASA has accumulated “a substantial body of knowledge of how to manage acute pain with minimal, if any, use of narcotics.

“We understand that one of the side effects of narcotics is delaying recovery, along with exposing patients to other, unnecessary side effects. We hope to get this information into the hands of non-anesthesiologists. Many prescribers of narcotics are probably unaware of their own excess-prescribing practices.

“One thing that has come to light around this opioid epidemic is that it’s very common for physicians to prescribe two to four times as many narcotics as the patient needs. “Those pills are typically not properly disposed of, so they either end up in the hands of others for abuse, or the patient will ‘evolve’ into using them when they don’t need them.”
Hannenberg says he sees prescribers are beginning to change their practices, based on better knowledge. “You can see that change going on nationally, even though we have many miles to go,” he says noting that the quantity of narcotics prescribed has begun to decline.

“It would be hard to find a state medical society or specialty organization website that does not have some guidance and information about improving prescribing practices. This is not about developing new knowledge; we know where the opportunities are to improve.”

What is really needed, Hannenberg says, is basic research to develop a non-addictive, potent pain reliever that is as potent as oxycodone, without the risk. “We need a drug breakthrough to get over the hump.”

Meanwhile, he says, Premier “has a strong body of experience working with health systems and clinicians in engineering change in practice.” The participating hospitals are “a pretty diverse group, so we will learn what we need to learn to scale up to a broader network.”