Collaborative Protocols between Physicians and Pharmacy Groups to Facilitate Opioid Reduction in the Napa-Solano Service Area

Abstracts from the Kaiser Permanente2018 National Quality Conference


Jeff Chen, PharmD; Diparshi Mukherjee, DO

From Northern California

Background: The opioid epidemic is responsible for 6 out of 10 drug overdose deaths and, since 1999, prescription drug deaths from oxycodone, hydrocodone, and methadone have more than quadrupled. Historically, the Napa-Solano Service Area had the highest usage of hydrocodone/acetaminophen combination opioid prescription count out of any other service area in Northern California. The opioid reduction committee, commenced in March of 2016, is meant to tackle the issue of opioid use with support from medicine and psychiatry and with collaboration from the pharmacy group.
Methods: Population: Napa-Solano’s high rate of opioid utilization. Intervention: Physician education, academic detailing, peer-comparison information, and opioid taper. Comparison: Northern California service areas outside of the Napa-Solano Service Area. Outcome measures: Total morphine milligram equivalents (MME) reduction, total opioid tablet reduction, total opioid/acetaminophen combination tablet reduction, total oxycontin tablet reduction, and total alprazolam tablet reduction.
Results: Quantitative findings: Total MME reduction; total opioid tablet reduction; total hydrocodone/acetaminophen combination tablet reduction; alprazolam (Xanax) reduction; oxycontin reduction; and trinity (any opioid + benzodiazepine + skeletal muscle relaxant combinations, including carisoprodol) reduction. Charts: Acetaminophen/Opioid Combination Prescriptions and Total Alprazolam Quantity Reduction.
Discussion: Establishment of site champions as point persons to facilitate communication of new opioid initiatives is vital to the success of the opioid reduction program. Assembly of the Opioid Reduction Committee with support from Chiefs of Medicine, Emergency Department, and Psychiatry is the key to obtaining buy-in. Pharmacy collection of opioid data and frontline escalation of appropriate prescriptions to providers fuel the momentum of opioid reduction initiatives. Intensification of current MME threshold to ≤ 50 MME. Implementation of 20-tablet opioid limit for nonsurgical and 50-tablet opioid limit for surgical patients allowing exception for complex orthopedic postoperative patients on a case-by-case basis.

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