Meritus Health of Maryland cut the prescribing of opioids by nearly 40% in the past fiscal year, Carrie Adams, chief quality and transformation officer for Meritus disclosed, calling the change “a really phenomenal result.” She added, “It’s the equivalent of taking 3 million tablets of Percocet 5, or 4.4 million tablets of Vicodin 5, off the streets, comparing fiscal 2019 to fiscal 2020.”According to the National Institutes of Health, “21% to 29% of patients who are prescribed opioids for chronic pain misuse them.  Between 8% and 12% develop an opioid use disorder, and 4% to 6% who misuse prescription opioids transition to heroin.  About 80% of people who use heroin first misused prescription opioids.”Given these numbers, in an effort to curtail the epidemic, Adams said Meritus officials “decided to start with us and see how much of an impact we could actually have."Michael Staley, pharmacy director at Meritus, led the charge after examining the health system's electronic medical records system.

Photo by Zach Vessels on Unsplash

“The first step was looking at the data and sharing that information with the providers at Meritus Medical Center and in the larger Meritus Health system.  Then it was a matter of helping providers use the lowest effective treatment,” Adams said. “That meant starting with the lowest dose, starting with the right medicine, and starting with the fewest days.”  For instance, having a physician opt to prescribe a nonopioid medication instead or referring a chronic pain patient to physical therapy.“We don't want to send the patient home with more than what they need,” Adams said.  And, even more importantly, the hospital did not witness an uptick in patient complaints, suggesting that lowering the frequency of prescribing opioids did not lead impact patient satisfaction.“For the most part, physicians, whether in office visits or the emergency department, have been able to explain the options and treatments to patients,” she said. “It was a really good relationship with the pharmacists at the hospital working with the doctors.  The really just took it for themselves and just ran with it.  Regular communication has helped people see the data and the progress.”The number of opioids in the market is regulated by Drug Enforcement Administration (DEA) quotas instituted by Congress.“The pharmaceutical industry flooded every corner of the country with 76 billion oxycodone and hydrocodone pills between 2006 and 2012 – out-sized and unjustifiable numbers of painkillers shipped with DEA approval and awareness,” Sen. Richard J. Durbin (D-Illinois) said. “The statute is clear that DEA must exercise its quota authority to serve as a gatekeeper and weigh the public health impact of how many opioids it allows to be sold each year in the United States.”However, critics argue that notable reductions in opioids both at hospitals and in the market in general is negatively impacting coronavirus patients on ventilators who rely on them to ease pain.  What’s more, it is believed the strict reductions in health care systems is only increasing the unregulated supply sold on the streets.  So, doing so has done little to reverse the epidemic.“Prescriptions drive the quota,” explained Ruth Carter, a 30-year veteran who retired from the Diversion Control Division. “It’s totally wrong that we could have controlled the epidemic by the quota.”

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Meritus cuts opioid prescriptionsThe DEA Is Keeping Opioids Away From Coronavirus Patients—And Isn't Even Stopping Street Drugs