As a response to the ever-escalating opioid epidemic in the United States, Piedmont Healthcare President and CEO Kevin Brown in June convened a task force to review how our health system should address this damaging public health crisis. The latest statistics show that there are 46,000 deaths annually involving opioids, including 929 in Georgia in 2016. From 1999 to 2010, opioid-related overdose deaths in Georgia increased by 500 percent.
As a result, we are at the point where every health system needs to examine its role in how to make a positive contribution to stem the epidemic. Research shows that some addictions have been driven by patients who receive opioids following surgery or to whom they are prescribed following an Emergency Room visit. A system with as many employees as ours, nearly 23,000, is not immune to the effects of the epidemic and it has touched some of our employees on a personal level. Gloria King, a manager of nursing programs at Piedmont Fayette Hospital, saw her 18-year-old son become addicted to opioids after being prescribed the drugs following the removal of his wisdom teeth and then again when he had an emergency appendectomy two months later. Two years later, he died of a drug overdose. In the past, physicians were taught that opioids were not addictive. Now we know that one-third of patients have a predisposition to become addicted.
Additionally, as the largest healthcare system in Georgia, treating two million patients annually and reaching 70 percent of the state’s population, Piedmont feels its leadership role acutely in needing to address the epidemic. We wanted our position and our commitment to pain management to align with our mission, which is to make a positive difference in every life we touch, and also to align with our values. It is our system’s 10-year strategic goal to do zero harm to our patients.
Our internal discussion in preparing our response included those in pain consultation services, pharmacy, emergency department, nursing, clinic, patient services, medical information systems, operations, compliance, community benefit, and government relations. We asked ourselves:
- What is our fiduciary responsibility?
- Where can we have an impact?
- What do we have capacity and competency to do?
- Do we want to take a community leadership role?
The consensus to that last question was a resounding yes. The guiding statement that we produced regarding our system’s use of opioids is that “Piedmont will provide patients with optimal pain management while seeking to prevent opioid abuse.”
Among the key tenets of our plan is education and awareness. We affirmed that we have a responsibility to educate patients on the issue. Our education program will work to inform patients who are chronically using or abusing opioids about all of the facts available about this class of drugs, particularly how highly addictive they are. Our message to patients will be that every time they visit one of our physicians we are here to provide great care and care management, some of which includes pain management.
In our internal research, we found that our hospitals were responding to the crisis but the response was not coordinated. It is one of the goals of the task force to coordinate our response. We also have provided leadership at the community level and now seek a larger role as a system.
One of our decisions is that we will modify our policies regarding how and when we use opioids. We will use them when appropriate and necessary but we also will use them judiciously every time a patient is admitted into the Emergency Department or into the hospital. We will consider non-opioids and alternate pain management modalities for treating acute pain. Alternatives we will consider include topical therapy, local injections, massage, acupuncture, chiropractic manipulation, NSAIDs, IV Lidocaine and nitrous oxide.
When we determine that opioids are necessary, we will use short-acting ones. Nonetheless, there are several subsets of patients where we will not change our policies. These include cancer patients, patients who suffer from sickle cell disease, and those who are receiving palliative care.
We will engage in a dialogue with our patients on managing their pain and limiting their expectations.
We will establish systemwide standardization and coordination of prescribing protocols in key risk areas. We also will consider systemwide efforts to improve pain management.
We will support and promote local community initiatives, along with a host of other recommendations.
Lastly, we will work to reduce the stigma regarding opioid addiction. With a problem that is the size and scope of the opioid epidemic, no single entity can turn the tide. However, if every organization that has a stake in the epidemic coordinates its response and takes a tougher stance and self-reflective examination on the use of opioids, we can all truly make a positive difference in the lives we touch.
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