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These drugs became more readily available to patients in the late 1990s, and prescription rates nearly doubled between 1998 and 2013. This epidemic is the unintended consequence of policy and practice that was supposed to benefit patients and keep them safe. A solution to this kind of systemic problem that affects the health, social, and economic welfare of society requires a large-scale, comprehensive course of action. The health care delivery system is ground zero. This article describes how Kaiser Permanente, one of the nation’s largest not-for-profit health plans, is working to reduce opioid abuse among its more than 10 million members, and offers insight for the health care system as a whole.
Misinformation about the use of opioids for chronic, non-cancer pain was a key driver of widespread overuse and abuse in the U.S. Kaiser Permanente physicians developed up-to-date evidence-based treatment guidelines for the proper use of these medications. Guidelines include:
- Focusing on alternatives to opioid therapy as a first-line treatment for chronic, non-cancer pain;
- Providing non-drug treatment options (such as meditation, guided imagery, and Tai Chi);
- Treating patients with the lowest dose of opioids possible, for the shortest duration necessary (in general, less than a 100 mg morphine equivalent dose per day, with no more than a 30-day supply at a time);
- Monitoring patients at risk for opioid abuse via questionnaires, urine drug tests, and prescription history on state prescription drug monitoring databases;
- Recognizing “red flag” behaviors that suggest dependence, misuse, or abuse (such as the need for escalating dosages, requesting refills before they are due, or requesting name-brand drugs, which carry a high “street” resale value); and,
- Using documentation tools to ensure communication and collaboration within and across specialties.