Could reducing pills per prescription ease opioid crisis?

Aug 28 2017

Could reducing pills per prescription ease opioid crisis?

As prescriptions for opioid painkillers increased dramatically over the last two decades, so too did the opioid epidemic.

According to the Centers for Disease Control, U.S. doctors wrote 259 million prescriptions for painkillers in 2012. While prescription rates have declined slightly since 2010, the CDC also says “sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been an overall change in the amount of pain Americans report.”

So when it comes to the opioid crisis, the connection (or is it causality?) isn’t hard to see.

But now at least one healthcare provider is pledging to do its part to turn the tide. But they aren’t looking to reduce the number of prescriptions, only the prescription orders.

Utah-based Intermountain Healthcare, which operates 22 hospitals and 180 clinics, recently announced a plan to reduce “the average amount of opioids prescribed per acute pain prescription” by 40 percent by the end of 2018. Simply put, they won’t be reducing the actual number of prescriptions, but the number of pills per script.

The company said patients often have a significant number of pills left over once their pain subsides, leading to abuse by the patient or their friends and family members. They hope that by reducing the number of opioids available per prescription, they will create less waste and reduce the risk of problematic use.

“Currently, nationwide, providers tend to write prescriptions for more opioids than patients need, and large quantities of the medications are often left over after the need for pain relief is past,” Dr. Doug Smith, associate medical director for Intermountain Healthcare, said in a statement. “We will follow best practices in prescribing, so the medications prescribed more closely match the needs of patients.”

To accomplish their goal, “Intermountain is adding prompts and default order sets into its electronic health records to help reduce the number of tablets prescribed,” according to their statement.

In a move that should please treatment professionals and advocates for chronic pain patients alike, the company said they will offer alternative pain management and treatment methods to make sure patient needs are still being met. They claim to have already trained over 2,500 staff members on the new initiative and will be expanding their training program in the near future.

Still, questions remain about how effective the new policy will be in reducing substance use disorders and problematic use. Many people addicted to prescription medications already engage in “doctor shopping,” or switching doctors to obtain more opioids when a prescription runs out. Intermountain’s new tactics may only force them to switch more frequently.

Intermountain also did not reference any study or research to back their plan, and The Influence staff were unable to find any significant information to support the hypothesis that fewer pills per prescription would reduce addiction rates. Still, it’s reasonable to assume that removing 5 million opioid tablets annually (Intermountain’s estimate should they reach their goal) would have a positive effect in one form or another.

But of course it’s also clear that the opioid epidemic is not contained to Intermountain’s patient base, and fighting the epidemic will require systematic change nationwide. Will other providers follow Intermountain’s model? Only time will tell.

  • Laura4444

    I had the worst broken pelvis my surgeon ever saw anyone survive. The pain lasting for most of a year was off the chart horrendous. It was hard enough going across town monthly for my pain med prescription, sitting in a wheelchair on disabled transport for several hours there and back. There is a difference between having wisdom teeth removed and a catastrophic injury like mine. I’m certain that the vast majority of people making across the board decisions like this have no clue what months of unrelenting, terrible pain is like. I had no idea either before this happened.

    I agree that drug ODs are heartbreaking but nobody seems to care about the steady stream of pain patients committing suicide because they’ve been cut off from their pain meds and can’t even get an appointment with a new doctor not because they’re abusing their prescriptions but because doctors are afraid of the DEA. Many pain patients can’t even get treated for non-pain related conditions, that’s how marginalized we’ve become.

    As for “alternative options for pain management” that is a load of highly questionable treatments. They mean antidepressants and anticonvulsants, which for many people cause serious side effects and life threatening withdrawals even with a slow taper. Or, they’ll pay for half an hour with a therapist to teach you how to meditate or to give you a lecture on how coloring books are the key to controlling your pain. And when it doesn’t solve your pain, well they’ll tell you that you just have to believe it’ll work and meditate harder. In other words, you deserve your pain because you’re obviously not smart enough to be able to think away your pain. An honest therapist will admit that these approaches will allow a patient to spread out their pain med doses by a few hours but certainly won’t replace them.

    I’m glad that there is a definite move to stigmatize addicts less in the past. The sad thing is that it seems like pain patients are replacing them as society’s newest pariahs.