Hospital-led Prescribe Safe initiative takes action against opioid painkiller misuse

Every day in the United States 44 people will die of overdose from prescription opioids – deaths that have more than quadrupled in the past decade and a half, according to the Centers for Disease Control and Prevention.

Reb Close, M.D., an emergency department (ED) physician at the Community Hospital of Monterey (Calif.) Peninsula (CHOMP), knows firsthand the toll that prescription opioid abuse takes on patients and communities.

“We saw it every day in the ED … our neighbors, the people in our community suffering because of medication misuse and diversion and overuse,” she says. “We had to do something.”

CHOMP, part of Montage Health, took action two years ago to address the crisis in its county of some 415,000 residents. It brought together more than a dozen organizations with a stake in reducing prescription drug abuse and misuse. The community-wide effort, called Prescribe Safe, includes the county’s four hospitals, district attorney’s and sheriff’s offices, public health clinics and urgent care centers.

It has led to a sharp decline in the number of patients coming to the ED because of opioid abuse and in the number of prescriptions for opioid painkillers.

“It was remarkably easy to get this coalition off the ground,” says Anthony Chavis, M.D., Montage Health’s senior vice president and enterprise chief medical officer. He described the initiative at an April 26 webinar hosted by the AHA’s Section for Psychiatric and Substance Abuse Services.

Chavis said the stakeholders recognized the need for joint action. “Everyone was engaged and understood they had a piece of the issue, but that no one piece could solve this problem. We had to solve it together.”

The group established guidelines for prescribing pain medications in the ED that are followed by all hospitals in the county. It has contributed to a 50% decline in opioid prescribing by physicians. “It is not that we don’t want to treat pain; we don’t want to treat every pain with opioids as we used to,” says CHOMP emergency physician Casey Grover, M.D.

Every patient who comes into an ED in the county gets a handout – in English and Spanish – about prescribing safe pain medications. A list of community resources is compiled for patients on drug and alcohol counseling and providers of alternative treatments such as acupuncture.

Prescribe Safe taught providers how to talk to patients about drug use without judgment. Providers work with law enforcement agencies to crack down on cases of unlawful purchase or distribution of opioids and other prescription painkillers.    

“We want to treat medical conditions – such as chronic pain – effectively and safely,” Chavis says. “If someone comes into our emergency department seeking controlled medications, we want to provide pain relief options that are safe and correct.”

CHOMP has referred more than 600 patients – those who had been frequently admitted to the ED for drug-related reasons – to care management programs that address their specific medical or behavioral needs. Since the program’s inception, recurrent ED visits related to opioid abuse have dropped nearly 60%.    

“We wouldn’t have engaged in this if we didn’t think we could move the dial,” says Chavis. “What we’re doing makes sense from both a financial and clinical standpoint.”

He says Prescribe Safe offers a model for others seeking to address opioid misuse and abuse in their communities. “The resources are out there,” he says. “You don’t have to re-invent the wheel.”