The current opioid epidemic has been declared a public health emergency — and could be the deadliest drug crisis in American history. Opioid overdoses killed more than 42,000 people in 2016, and along with destroying lives and devastating communities, opioids are wreaking havoc in the workplace.1 One survey showed that 70% of employers have been affected by problems related to prescription drug use, including absenteeism, impaired performance, and workplace injury.2
Through education and support for patients and prescribers, Kaiser Permanente has been working to address the opioid epidemic for nearly a decade, with multidisciplinary initiatives designed to:
- Limit opioid prescriptions overall, prescribing them only when it’s safe and appropriate
- Provide effective, patient-centered, nonopioid pain management alternatives
- Prescribe lower doses and shorter courses when opioids are medically necessary
- Help patients who take opioid medications taper down to safer, lower doses — or discontinue use altogether.
- Eliminate brand-name opioids whenever possible to help prevent diversion into communities
We have dramatically reduced our members’ risk for opioid abuse and addiction — through improved prescribing and dispensing policies, monitoring and follow-up processes, and coordination across departments and specialties.
Reducing overuse, misuse, and abuse through integration
It’s our integrated care delivery system and seamless coordination that make our opioid management programs possible — and successful. In our unique model, members, providers, hospitals, medical offices, pharmacies, and laboratories are linked together in one connected system. Physicians and care teams from our primary and specialty care, pain management, and addiction medicine departments work closely with each other — and with our pharmacists — to provide effective pain relief without putting our members at risk for opioid-related complications. We accomplish this through:
- Provider education. Clinicians receive up-to-date training in pain management best practices, along with strategies for avoiding prescribing long-term opioids to patients who have never used them.
- Rx tapering programs. Multidisciplinary teams are available to help members who already use opioids lower their doses to safer levels or discontinue use altogether.
- Patient therapy plans. When opioids are clinically appropriate, we prescribe them safely — and educate members about the risks associated with opioid therapy. We also regularly monitor members taking opioid medications through regular office visits, phone calls, and drug screenings.
- Digital safety alerts. Our electronic health record system alerts physicians about duplicate opioid prescriptions, and our pharmacy teams review early refills and other potential signs of opioid abuse.
Promising results, proven success
Specific details of our opioid management programs may vary by region, but the goals, methodologies, and core practices are consistent — and proven to be highly effective. For example, our opioid management efforts in Southern California between 2010 and 2015 resulted in:
98% fewer prescriptions for more than 200 pills
Limiting the number of pills and duration of use reduces the likelihood that patients will become chronic users. The risk for long-term use increases after just 3 days, and continues to rise rapidly after that.4
90% fewer opioid prescriptions in combination with benzodiazepines and carisoprodol5
Combining these medications amplifies the risks associated with them. All 3 suppress the central nervous system — which can cause slow or difficult breathing that can be fatal.6
95% fewer brand-name opioid prescriptions when generic is available7
Generic opioid medications are less likely to be diverted into the community, because people who intend to misuse opioids typically seek out well-known, brand-name drugs, such as Percocet.
Spreading opioid best practices across Kaiser Permanente
Our integrated system enables new ideas and practices to spread faster, so we can start seeing large-scale improvements sooner. After early successes in several of our regions, providers and pharmacists across Kaiser Permanente shared their learnings and methods quickly — and continued to achieve positive results.
Since expanding the program, the overall volume of opioids prescribed has plummeted at Kaiser Permanente — falling by more than 40% between January 2011 and February 2017 across our program.8 Plus, we reduced the number of high-dose opioid prescriptions in every region we served between 2014 and 2017.9
- Northern California — 38%
- Southern California — 36%
- Colorado — 37%
- Georgia — 32%
- Hawaii — 47%
- Mid-Atlantic — 47%
- Northwest — 55%
Only with an integrated care delivery model like ours could such an effective end-to-end approach to opioid management be implemented — and the results be measured, scaled, and shared beyond our walls to show other health systems what they can do to help end the opioid epidemic.
1 “Drug Overdose Death Data,” Centers for Disease Control and Prevention, 2017.
2 “How the Prescription Drug Crisis Is Impacting American Employers,” National Safety Council, 2017.
3 Jan L. Losby, PhD, MSW, et al., “Safer and More Appropriate Opioid Prescribing: A Large Healthcare System’s Comprehensive Approach,” Journal of Evaluation in Clinical Practice, July 14, 2017.
4 Anuj Shah, et al., “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015,” Morbidity and Mortality Weekly Report, March 17, 2017, p. 265.
5 See note 3.
6 U.S. Food and Drug Administration, September 20, 2017.
7 See note 3.
8 Kaiser Permanente internal data. Reduction in overall morphine milligram equivalents prescribed between 2011 and 2016, adjusted for membership population growth.
9 Kaiser Permanente internal data. Reduction in prescriptions for 90 morphine milligram equivalents or more per day between 2014 and 2017.