How Hospitals Are Battling the Opioid Epidemic

At the front lines of the opioid crisis, health care providers and hospitals are reconstructing their approaches to treating pain and addiction, from implementing new prescription guidelines and creating personalized systems of care to addressing addiction as a disease rather than a moral failing.

"We all had to start this at about the same time," Dr. Halena Gazelka, director of inpatient pain services within Mayo Clinic's pain medicine division, said during a panel discussion this week on hospitals' role in the opioid epidemic during U.S. News' annual Healthcare of Tomorrow conference. "Everybody got concerned about the opioid crisis at about the same time, so there was no pattern, there was no game plan to follow when we've all kind of had to work at it along the way."

Gazelka, based in Minnesota, was joined on the panel by Dr. Alicia Jacobs, vice chair of clinical operations and a family medicine physician with the University of Vermont Medical Center; Christopher Freer, chairman of Saint Barnabas Medical Center's emergency department in New Jersey; and Jay Bhatt, senior vice president and chief medical officer of the American Hospital Association.

One of the first things the University of Vermont Medical Center had to do to confront the opioid crisis was change physicians' mindsets, Jacobs said.

"Really, the bottom line is, this is hard care to do," Jacobs said. "We had to realize that this is a chronic, relapsing, remitting disease and if you already understand this, thank goodness. If you don't understand this, then I want to explain to you this is just like diabetes (with) chronic relapsing. … That's what we need to apply to this population as well."

Aligning with Vermont’s hub-and-spoke system for opioid addiction, providers affiliated with the medical center have integrated drug treatment into their practices. These patient-centered medical homes offer a team approach to address a patient's health issues and promote a healthy lifestyle, Jacobs said. "This care should be normalized and just integrated into what we do every day," she said.

"If you're going to address chronic disease and bend the cost curve in value-based care, then you really have to develop a model where we leverage our primary care work for us, and then the specialist is the one who the patient goes to see," Jacobs said. "We've now gotten to a place where, literally, our physicians are saying, 'Oh my God, this is the most meaningful care I do. I have leaned into something that I felt uncomfortable with. I am serving a community that was completely underserved. And I literally can see the change. This is such meaningful care.'"

Meanwhile, Freer said Saint Barnabas Medical Center and other RWJBarnabas Health facilities have integrated peer recovery specialist programs into their emergency departments to help patients with substance use disorder.

After observing how receptive both staff and patients were to the specialists – who themselves are in long-term recovery from substance use disorder and provide intervention and support – Freer said they're spreading the services into in-patient units as well.

"We already had a predisposition (of), when we walked in as providers, 'I have nothing for you, and I'm not going to be part of the problem and give you a prescription.' And that's a really negative interaction," Freer said. But "the peer recovery specialists, if you listen to one of them talk and hear what they're going through, and then you watch what they do at the bedside, it's contagious for the rest of the staff. So it's really been a cultural shift."

In terms of reconstructing hospitals' prescription habits, Gazelka said Mayo Clinic has developed its own recommendations for acute and chronic pain prescriptions based on guidelines issued by the Centers for Disease Control and Prevention and others.

Yet hurdles remain, as differences in state laws can make it difficult or confusing for providers trying to treat varied kinds of pain.

The guidelines "were intended to inform primary care providers how to monitor patients who are receiving chronic opioid therapy. Used that way, they actually are very reasonable," Gazelka said. "The problem is that everybody wanted to do something, and so all of a sudden, we see all this legislation being passed in states that you can only prescribe for three days, you can only prescribe so many pills. And it came from the CDC guidelines, essentially, where they were getting those numbers, which was a misuse of them.

"They were not intended to inform how to prescribe acutely, which is what those laws are intended to legislate," she said.

In the meantime, Bhatt – of the American Hospital Association – said support for those suffering from opioid addiction shouldn't stop once a patient leaves the hospital.

"I think the conversation that's been accelerating around social needs, social determinants, health equity, stigma – all are not separate from the issues of opioid use disorder," Bhatt said.