Finding a Solution for the Opioid Crisis

How health IT is helping clinicians battle the opioid epidemic

Opioids killed more than 72,000 people in 2017. Once believed to be an effective and safe answer for acute and chronic pain treatment, research and statistics now show it isn’t always the safest option. Health IT, paired with clinicians’ reassessment of the issue, has sights set on reducing the likelihood of opioid addiction, overdose and, ultimately, avoidable deaths—all while still providing the care patients need.

How did the Opioid crisis start?

DH: Like many complex problems, there is no single factor. To start, I think it’s important to look at an often-mentioned, highly influential five-sentence letter published in the New England Journal of Medicine in 1980 , which described the

1 use of opioids to treat pain in hospitalized medical patients, finding very low rates of addiction in this group.

Over the years, that letter was repeatedly cited as evidence that risk for opioid addiction is low , particularly in

2 treating chronic pain, which is completely at odds with the conclusion of its authors.

There are physician factors, including often-limited education during training in treating chronic pain and a desire to effectively treat those who are suffering.

And of course, the marketing efforts of opioid manufacturers in the 1990s, which downplayed risk for opioid addiction (they were reading that 1980 letter as well), contributed substantially to the opioid crisis we’re fighting against today.

How can healthcare IT support a safe, secure prescribing process?

DH: Healthcare IT has several touch points that can help reduce risk of opioid misuse and inappropriate prescribing of opioids. For clinicians, seamless access to state Prescription Drug Monitoring Program (PDMP) databases within the EHR can help detect “doctor shopping” as well as validate legitimate use of opioids. Electronic prescribing of controlled substance (EPCS) technology, using twofactor authentication, substantially mitigates risk for drug diversion. It’s also essential for physicians to have point-of-care clinical decision support to equip them with evidence-based guidance to determine whether an opioid is appropriate. And, if it is appropriate, use the lowest effective dose and duration to minimize risk for opioid misuse, overdose and death. Finally, analytics is crucial to understanding opioid prescribing patterns and overdose rates—nationally and locally. Descriptive analytics can identify “outlier” prescribers, those physicians who may be inappropriately prescribing opioids. With this information, health systems can contact these clinicians, and if prescribing is felt to be excessive, provide education and follow up with ongoing monitoring.

Predictive analytics, which involves machine-learning techniques, will likely begin identifying patients at the point of care who are at increased risk for chronic opioid use before an opioid is first prescribed.

What do these technological advancements mean for clinicians?

DH: First, clinicians must acknowledge their role in contributing to the opioid crisis, as well as reassessing the approaches to treating acute and chronic pain with opioids. Personally, by using clinical guidelines, I have substantially changed my approach in treating acute pain by more critically considering whether an opioid is necessary, and if so, finding the lowest effective dose and shortest duration. Since acute or chronic pain is often one of multiple issues clinicians address during an office visit, it is critical that efficient, comprehensive healthcare information technology tools are available—all within the clinician workflow.

What would be the ideal collaboration of different industries to combat the opioid crisis?

DH : Since no single entity can effectively address the opioid epidemic, a collaborative—national and regional—approach is necessary. This approach involves government and public health agencies, law enforcement, health systems, clinicians, healthcare IT vendors, pharmaceutical companies, patients and others. These efforts will take time and be challenging, but are critical to helping individuals currently addicted to opioids, and preventing future opioid addiction.