Intermountain Cut the Number of Opioid Pills Prescribed by 30%

While the reduction is impressive, it's still short of the 40% reduction goal set forward by the Utah-based health system when it announced the initiative in 2017.

Intermountain Healthcare reduced the number of opioid tablets prescribed to patients in acute pain by 3.8 million in 2018.

The 3.8 million fewer opioid pills prescribed by the health system in 2018 represents about a 30% reduction, falling short of the 40% reduction that Intermountain had targeted when it announced the initiative in 2017.   

Intermountain executives say they're proud of the success, but will use 2019 to drill down into health system operations to identify opportunities to reduce opioid prescriptions by 5%.

"We knew these would be lofty goals and we're encouraged by the reduction in opioid tablets and the success of our other opioid-reduction efforts. We knew these were the right steps to take," said Intermountain CMO David Hasleton, MD.

"We're continuing our focus to implement appropriate evidence-based opioid treatments, provide alternative forms of pain control for our patients, and educate providers and the public about the safe use of opioid medications," Hasleton said.

Among the accomplishments touted by Intermountain:

• Intermountain exceeded its goal to increase medically-assisted treatment for opioid use disorders by more than 10%.
   
• Intermountain reduced by 29% the number of patients prescribed both opioids and benzodiazepines, the combination of which could suppress breathing.
   
• Intermountain pharmacy drop-boxes have received over 26,000 pounds of medication since February 2015. Intermountain has also helped give out more than 2,644 naloxone kits.
   
• Intermountain pharmacies offer naloxone kits for purchase without a prescription and the system has helped to fund additional kits for nonprofit Utah Naloxone.

Lisa Nichols, Intermountain Healthcare’s Community Health executive director, spoke with HealthLeaders about the health system's efforts to reduce opioid prescriptions. The following is an edited transcript. 

HLM: How did you recognize that you had a problem with opioid prescriptions?

Nichols: We as a health system certainly watched the morbidity and mortality incidents and prevalence data in our community at the time we started our opioid initiatives. For several years, Utah was in the Top 10 in terms of overdose deaths and we're the largest health system in the state. If we've got a large number of overdose deaths, we understood that we have to intervene.

HLM: Initially you sought a 40% reduction in opioid prescriptions. How did you come to that number?

Nichols: We had surveyed about 16,000 patients post surgery around how many of the tablets they were given, did they use them and how did they dispose of their medication. We learned that most people were using 50% or less of the tablets that we were giving them. That really helped us feel comfortable that we could prescribe at least 40% less and still adequately manage people's needs.

HLM: You fell a little short of that goal. What happened?

Nichols: With each percentage reduction it became incrementally harder. We had some really good improvements at the beginning and then and then it just became harder. It's hard to find that balance between treating pain and ensuring people were safe.

HLM: Do you still consider the initiative a success?

Nichols: We're proud of where we got, but a lot of 2018 was also spent building the infrastructure to support this work. We put up digital dashboards and we did a lot of education with leaders and we have a continuous improvement huddling system for our goals.

We think that we can go further now that we have this incredible foundation set and we're able to drill down on who are high prescribers or are there geographic areas or facilities that are problematic. We think we can get at least another 5% reduction.

At least part of that 30% was the low-hanging fruit and that's why it got incrementally harder. But now we really can focus in, to the detail of are there specific procedures where they're prescribing more? It's not just focusing on prescribers. We continue to focus on our community and their awareness of the dangers of opioids, their understanding that over the counters are really effective.

We want to continue to build that knowledge and empowerment of our patients to say to their prescribers. "Do I really need this?"

HLM: Where do you go from here in 2019?

Nichols: We have this 40% goal as a system and one of our improvements this year is we're now able to look at each clinical program and we can see where they are in their prescribing. If we want to get an additional 5%, how much would each clinical program need to reduce? So we're working much more granularly with each clinical program around "this is our expectation for your program. Is that realistic?" We're doing it in a much more targeted way.

HLM: What sort of patient metrics are you seeing that would indicate this initiative is working?

Nichols: Utah is one of only a handful of states that saw a decrease in opioid overdose deaths last year. We had a 12% decrease in overdose death. That's multifaceted. It's also because Naloxone has become much more available and treatment as become much more available. You need all of those components for this very complex problem.