Billion Pill Pledge could greatly reduce leftover opioids
News of the opioid crisis has inundated the headlines in recent years. Despite the attention this problem has received, America experienced a record number of overdose deaths last year.
While we are nowhere near the end of this public health tragedy, I believe the first rays of sunshine are peaking over the horizon.
Opioid lawsuit settlements now total over $50 billion. On the heels of a $500 million settlement with Walgreens, New Mexico is expected to receive nearly $1 billion for opioid prevention, treatment and recovery. In fact, some of those funds have already been received in our state.
With that in mind, I was heartened to see recent news from the states of Iowa and Tennessee. Surgery is a key gateway to persistent opioid use and dangerous leftover pills. The Billion Pill Pledge program, supported in both Iowa and Tennessee, takes an innovative threepronged approach to opioid first-dose prevention around surgical procedures, including:
Education and implementation support to providers for delivery of care according to opioid-minimizing Enhanced Recovery After Surgery (ERAS) protocols
Disciplined prescribing of opioids after surgery
Appropriate disposal of leftover opioids after surgery
The Iowa program recently reported a 70% reduction in opioid pills after surgery at participating hospitals. This result comes 15 years after the implementation of Iowa’s Prescription Drug Monitoring Program, demonstrating that these databases are an important tool in the opioid crisis, but not a total solution.
The mission of the Billion Pill Pledge extends beyond these two states to a national goal of eliminating 1 billion leftover opioid pills from our homes and communities, pills dispensed after surgery that could otherwise lead to misuse or diversion.
I believe this program can serve as a model for many other states, including New Mexico, which are making critical opioid settlement investment decisions in real-time. Here’s why:
FOCUS ON EVIDENCE-BASED PREVENTION: Enhanced Recovery After Surgery protocols, developed in Europe in the 1990s and later adopted in the U.S., have proven to improve surgical outcomes and decrease post-surgical complications. An additional critical element of these protocols — multimodal pain management — has time and again demonstrated the ability to help patients achieve better pain management with fewer opioids.
Minimizing narcotics not only decreases the risk of addiction, but also reduced costs and decreases surgical complications and hospital length of stay. At a time when our health care system is under greater stress than ever, these additional benefits and savings are critically important.
FOCUS ON AT-RISK POPULATIONS: In my role as a surgeon, I see many patients over the age of 65 and many other patients who are enrolled in Medicaid. Both populations are at-risk.
For instance, more than 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2021. Further, in research published earlier this year, Stanford researchers found among Medicaid patients who had never taken an opioid, 30% developed an opioid dependency following their first prescription. Nearly 1 in 3.
Clinically-validated, opioid-minimizing ERAS protocols, the foundation for the Billion Pill Pledge program, have repeatedly demonstrated an ability to reduce health disparities.
FOCUS ON PROVIDER EDUCATION
AND SUPPORT: As a surgeon, I can tell you there is still much work to do with opioid prescribing and pain management around surgery. We have two decades of misinformation and misguided prescribing to correct.
It is not going to happen by itself. It is not going to happen through regulations alone. And it most certainly is not going to happen without engaging with prescribers, providing education and support where it’s needed.
So much has gone wrong in the creation of the opioid crisis over the last 20 years. Let’s get this — hopefully — final chapter right.