Prisma Health develops successful pain management model to reduce opioid dependency risk

Proven strategies have reduced opioid prescribing by 46% in Prisma Health Upstate hospitals and practices 

Greenville S.C.—Prisma Health’s innovative response to South Carolina’s opioid epidemic has resulted in steady declines in opioid prescribing and could serve as a national model for fighting this challenge.

Prisma Health’s Opioid Stewardship Council is a multidisciplinary group of expert physicians and pharmacists that developed the pain management and tracking recommendations adopted at its Upstate hospitals and physician practices, which resulted in a 46% total reduction in opioid prescribing from 2017 to 2020. Opioids are a class of highly addictive “painkiller” drugs that include narcotic prescription drugs such as codeine, fentanyl, hydrocodone, hydromorphone, morphine, oxycodone and tramadol.

Lowering the amount of opioids prescribed and providing alternative pain therapies are proving successful for patients who need to manage post-operative and chronic pain. This approach greatly reduces their risk of developing an opioid dependency. In addition, prescribing fewer opioids reduces the amount of overall opioid availability in the community that might be abused.

From 2014–2019, South Carolina saw a 72% increase in prescription opioid overdose deaths, due in large part to the increased availability of synthetic opioids in the community, according to the South Carolina Department of Health and Environmental Control (SCDHEC).  National studies have shown that approximately one in eight patients who receive narcotics for the first time after a procedure will become persistent users.

“Addiction does not discriminate,” said Dr. Alain Litwin, Prisma Health addiction medicine specialist, “because almost everyone in their lifetime experiences a very painful condition, temporary or long-term, which makes them vulnerable to these powerful drugs.” Litwin also serves as executive director of the Addiction Research Center and vice chair of academics and research for University of South Carolina School of Medicine Greenville. “Opioid addiction is a serious risk for anyone who needs pain management following an injury, a medical procedure, or even dental work. Across the nation, the rise of opioid addiction and abuse has tragic consequences for families and entire communities.”

Litwin and pain medicine specialist Dr. Kevin Walker are co-chairs of the Prisma Health Opioid Stewardship Council, and on staff at Prisma Health Greenville Memorial Hospital. Other leaders of the Upstate committee include Doug Furmanek, PharmD, clinical director of pharmacy services; Vito Cancellaro, MD, anesthesiologist; Dawn Blackhurst, clinical data analysis manager; and Drew Albano, DO, vice chair of quality and medical staff affairs. Resources offered by the group include scheduled presentations, office hours and phone consultations for colleagues and prescribers seeking updated guidance. So far, approximately 1500 Prisma Health doctors have received updated training in safe prescribing and pain management without opioids.

“Reducing the widespread use of narcotics requires a culture change among prescribers, so education outreach is key,” Dr. Walker said. “While opioids are an important tool in medicine, Prisma Health has been able to significantly reduce the opioids being dispensed upon discharge. Pain management plans can successfully minimize or avoid dependency risk in many circumstances.” He also emphasized that fewer opioid prescription bottles in household medicine cabinets also significantly reduces the number of pills falling into the hands of potential drug abusers.

Key components of the Prisma Health opioid model include:

• Improved education for patients, nurses and doctors about opioid dosage and alternatives.
• Integrating the statewide Prescription Drug Monitoring Program (PDMP) into electronic health records for improved tracking.
• Monthly data review by visit type, facility, medical specialty, procedure/diagnosis to provide feedback to change the opioid prescribing culture.
• Consistently decreasing prescribed morphine milligram equivalents (MME) across all medical specialties (MME is a measurement unit used to calculate opioid dosage).
• Providing patients with alternative and effective pain therapies, in addition to realistic expectations for pain management. Examples include: physical and occupational therapy, cognitive behavioral therapy, interventional therapies and non-opioid pharmaceuticals.

Prisma Health’s innovative opioid management approach is being expanded to its hospitals and physician practices in the Midlands. In addition, due to frequent medical presentations, Prisma Health is helping to establish best practices in pain management across South Carolina and the United States.

About Prisma Health

Prisma Health is a not-for-profit health company and the largest healthcare system in South Carolina. With nearly 30,000 team members, 18 hospitals, 2,947 beds and more than 300 outpatient sites with nearly 2,000 physicians, Prisma Health serves more than 1.2 million unique patients annually in its 21-county market area that covers 50% of South Carolina. Prisma Health’s goal is to improve the health of all South Carolinians by enhancing clinical quality, the patient experience and access to affordable care, as well as conducting clinical research and training the next generation of medical professionals.