Douglas R. Oyler, PharmD, Kristy S. Deep, MD, Stephanie M. Abel, PharmD, BCPS, Kimberley B. Hite, MS, PharmD, Phillip K. Chang, MD, MBA
University of Kentucky, Lexington, KY
In order to develop an appropriate response, hospitals and health systems must appreciate the historic and ongoing contributions of prescription drugs to the opioid crisis. The majority of opioid use disorder cases begin with the misuse of prescription opioids obtained through the health system as part of routine care. Additionally, opioids prescribed for many indications often go unused, suggesting that the development of opioid stewardship programs could have a profound impact on the opioid crisis.
As an academic medical center and referral center for many Central Appalachian counties—which have been disproportionately affected by nearly every aspect of the opioid crisis—UK HealthCare in Lexington, Kentucky recognized the need for grass roots leadership to guide responsible opioid prescribing. We therefore established the Office of Opioid Safety, led by a pharmacist who reports to our Chief Medical Officer, in 2017. This office coordinates multidisciplinary projects across the UK HealthCare Enterprise, the state of Kentucky, and nationally. Since inception, the Office has lead the institution’s Opioid Stewardship Committee, which aims to reduce the risk of harm from opioid treatment and equip providers with the knowledge, skills, attitudes, and tools to safely prescribe opioids for analgesia. This multidisciplinary committee facilitates development of opioid prescribing protocols, patient education materials, and electronic health record improvements; tracks data regarding over 25 opioid-related metrics; and conducts academic detailing sessions with prescribers and other healthcare providers.
Subsequent to the Office’s inception, inpatient opioid use at the institution has decreased 25%, or the equivalent of 250,000 oxycodone 5mg tablets (approximately 1 tablet per hospital admission across all populations) annually. High risk opioid use (e.g,. doses over 90 MME per day or combinations of opioids and benzodiazepines) has decreased by over 50%, and the percentage of opioid-naïve patients discharged with new opioid prescriptions has decreased by two thirds with over 1,800 prescriptions avoided per year. Populations with the most intensive interventions, such as pharmacist detailing and changes to service-specific order sets, have shown more dramatic results; for example, the orthopedic service line has reduced high risk opioid use 75% and overall opioid use 12.5 MME per patient per day without sacrificing analgesia.
The positive impact of this program has also facilitated collaboration with the state government and hospital organization to develop similar programs at over 100 of the 120 hospitals and health systems via the Kentucky Statewide Opioid Stewardship initiative. This initiative focuses on reducing opioid overprescribing, improving safe opioid use, and providing a mechanism for hospitals to demonstrate their actions and commitments to their patients and communities to combat the state’s opioid crisis. Finally, the Office has been afforded numerous opportunities to create change on a national level and has expanded the role of a clinical pharmacist beyond cultural norms.