Addressing the Opioid Epidemic By Rethinking America’s Pain Management Paradigm
At Worrell’s 2019 Clinical Advisory Board event, Dr. Jacob Hutchins gave a passionate and powerful presentation about the medical profession’s role in the opioid epidemic (You can watch the full video above). Dr. Hutchins, an anesthesiologist who is also the executive director and chief medical officer of the University of Minnesota Health’s Ambulatory Surgery Center, called upon his research and life experiences to explain the stats of the opioid epidemic, how we got to this point, and what healthcare professionals can do to make the situation better.
THE TRAGIC STATS OF AMERICA’S OPIOID EPIDEMIC
Dr. Hutchins typically presents to other pain management experts, so he thought he might need to change up his presentation to deliver it to Worrell’s team of healthcare designers. But since the opioid epidemic affects everyone, he decided to share the same information with the designers at Worrell as he does with pain management experts. He started his presentation saying, “This will be helpful for your day jobs as healthcare designers, but it will also be helpful in your personal lives, as patients, and as family members of patients, because this issue affects everyone, across all social and economic demographics in America.”
The stats regarding the magnitude of the opioid epidemic support Dr. Hutchins’ claim that this issue affects everyone. He reported, “There are more deaths per year from drug overdoses than the total number of Americans that died in the Vietnam War.” Speaking at the Worrell headquarters in Minneapolis, he captured the audience’s attention with stats specific to Minnesota. He explained, “In Minnesota more people die per year from opioid related deaths than from motor vehicle related deaths.” The number of deaths related to the opioid epidemic is staggering and they continue to grow.
THE OPIOID EPIDEMIC, FUELED BY UNINTENDED CONSEQUENCES
In the early 2000s many well-intentioned programs, developed to minimize patient suffering, led providers to overprescribe opioids. Dr. Hutchins explained how the phenomenon of referring to pain as the fifth vital sign and the inclusion of patient pain in the HCAHPS survey incentivized doctors to prescribe more opioids. Many surgeons didn’t want to risk their facility getting a poor HCAHPS ranking for pain management, so they defaulted to prescribing high numbers of opioids for every procedure.
Other initiatives, such as poorly designed EMRs, also led providers to overprescribe opioids. The introduction of EMRs in the early 2000s overwhelmed many doctors who had low technological literacy. In an effort to minimize their engagement with the frustrating EMR systems, many doctors set a high number of pills as the default prescription and rarely adjusted it. Their fear of navigating the EMR numerous times was far greater than their fear of their patients having left over pills. Dr. Hutchins claimed that many surgeons still take this approach to prescribing medication after surgeries. They don’t want to get bothered by a patient wanting a refill, so they just prescribe a high number of pills right after surgery. Treating pain as the fifth vital sign, including pain in HCAHPS scores, and poorly designed EMR systems converged to create the perfect storm of over-prescribing in the early 2000s.
“The Fairview system, my employer, prescribed 24 million opioid pills in 2017. And that’s just one of about ten hospital systems serving a state with a population of about five million people.”
Research shows that overprescribing leads to diversion, misuse, and abuse. One study showed that the average patient reported taking only ten of the opioid pills they were prescribed after a surgery, but the average prescription was thirty pills. Most people reported keeping the remaining pills in their home anyway. This prescription surplus contributes to creating the ecosystem where 83% of opioid users do not have an opioid prescription. Dr. Hutchins said that his own institution may be contributing to the problem of overprescribing. He said, “The Fairview system, my employer, prescribed 24 million opioid pills in 2017. And that’s just one of about ten hospital systems serving a state with a population of about five million people.” The abundance of pills entering the community combined with the lack of programs to help people recover from opioid dependence leads to widespread abuse of prescription opioids and increased demand for less expensive substitutes such as heroin.
HOW CAN THE HEALTHCARE INDUSTRY IMPROVE THE SITUTATION?
1. Challenge Status Quo Thinking About Pain Management And Opioid Use
Dr. Hutchins believes it’s important to alleviate patient pain, but he sees the need to develop more realistic expectations regarding pain. He said, “America is different from the rest of the world. Americans expect to have surgery and not experience any pain, and that’s a huge issue. The reality is, if you’re getting cut open, you’re going to have pain.” Promoting the belief that patients should never feel any pain contributes to catastrophizing and overprescribing pain medication, so healthcare professionals must work to reshape the belief that patients should never feel any pain, while still striving to discover better techniques for managing pain.
In addition to challenging American expectations regarding pain, Dr. Hutchins wants to challenge American doctors’ reliance on opioids as the primary form of pain management, saying, “I don’t buy it as a fact when people say ‘you need opioids for this surgery’ when in India you can get a total knee replacement and you get Tylenol and NSAIDs. The patients there still do fine and they still have good outcomes.”
“Doctors, stop writing giant prescriptions just so you don’t have to be bothered.”
2. Stop Over Prescribing
The belief that a surplus of opioid prescriptions fuels the problems of the opioid epidemic was a central theme of Dr. Hutchins’ presentation. He challenged the medical community directly, saying, “Doctors, stop writing giant prescriptions just so you don’t have to be bothered.” Evaluating the unique needs of each patient’s pain management situation takes time, but it is worth it. Providing the appropriate amount of prescription medication could save lives and unburden the healthcare system.
3. Develop Alternative Forms of Pain Management
The work at Dr. Hutchins’ surgery center demonstrates how it’s possible to manage pain without opioids. When he started at his current surgery center, his colleagues who had been working in anesthesiology for 25 years said they had never done a procedure without opioids, but today Dr. Hutchins has developed a system where they treat about 40% of his patients with a multimodal, non-opioid approach.
Dr. Hutchins emphasized that doctors must remember there are many viable alternatives to opioids, saying, “We have a lot of other medications out there. We have alpha agonists, ketamine, NMDAs, and Magnesium has proven to be a great pain killer.” He also argued that the healthcare industry should dedicate resources to developing the literature to support nontraditional forms of pain management that have proven effective with certain populations such as reiki, massage therapy, pet therapy, acupuncture, relaxation techniques, and virtual reality.
THE FUTURE OF HEALTHCARE
As a global design firm specializing in healthcare innovation and strategy, we are excited to have Dr. Hutchins on the Worrell Clinical Advisory Board. If you’re interested in learning more about the experts and institutions we collaborate with and the way we are designing a brighter future for healthcare, please reach out. We look forward to starting the conversation.