In modern medicine, doctors may treat pain as one of a patient’s vital signs (along with temperature, respiratory rate, pulse rate and blood pressure). Patients expect to go to the doctor and have their pain issues resolved, and the doctor focuses on having the patient be pain-free as their treatment goal, too. The patient ends up leaving the office with a prescription for pain medication in many instances.
This reliance on pills to solve the problem of pain is one of the driving factors behind the rising opioid addiction rates. The American Society of Addiction Medicine (ASAM) states that 80 percent of new heroin users started with prescription pain medications.
Geisinger Health Systems decided to change its culture internally, cutting the number of opioid prescriptions prescribed in half. Physicians focused instead on recommending pain management that combined physical therapy, along with making changes in diet and behavior.
The number of opioid prescriptions written decreased from 60,000 per month (on average) to 31,000 per month since 2014. Part of the policy’s success was due to electronic data collection and changing to electronic prescribing.
The highest-prescribing doctors for opioid prescriptions were identified by the electronic provider dashboard. These doctors were provided with the latest research about best prescribing practices; the research was eventually shared with doctors throughout the system.
Physicians were encouraged to consider alternatives to medication for patients experiencing pain. They were also directed to use the Prescription Drug Monitoring Program available in the state to prevent doctor shopping, a practice where some patients visit multiple physicians seeking prescriptions for narcotic pain medications. It is one of the ways in which those addicted to opioids get pain pills, and it also provides a supply for the illegal pain pill market.
Geisinger’s chief pharmacy officer, Mike Evans, explained that doctors deal with patients on an individual basis. They aren’t considering population data when they decide on a course of treatment. Most of the doctors, when their prescription numbers were placed in front of them, didn’t realize how many prescriptions for opioids they were writing each month.
Previously, doctors would have prescribed 10 days or 30 days’ worth of opioids to treat post-surgical pain. Now, a doctor will explain to a patient that he should expect a certain degree of pain in the days and weeks following surgery. Pain is treated with alternating doses of Tylenol and Motrin or Ibuprofen. Patients who do get prescriptions for opioids are limited to a seven-day supply.
Controlled substances are prescribed electronically with a two-step process to authorize a prescription. Once the prescription is prepared, it is sent directly to a pharmacy. This procedure is for security measures to eliminate the possibility of the prescription being altered in any manner.