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The COVID-19 Pandemic and the Importance of Opioid Stewardship

Most Americans are aware of the disastrous national impact of the ongoing opioid epidemic. The Centers for Disease Control and Prevention tells us that since 1999, Americans have experienced a six-fold increase in opioid-related overdose deaths. In 2018, nearly 47,000 people died from an opioid overdose, which equates to 128 deaths per day. Expanding from 1999 to 2018, over 232,000 Americans died from overdoses involving prescription opioids. Although the opioid crisis has been a problem for many years, it was not officially declared a public health emergency until October 2017.

The Impact of COVID-19 on the Opioid Crisis

The COVID-19 pandemic has forever impacted and changed many facets of our daily life. Individuals with substance use disorder have felt the impacts of the pandemic especially hard. Not only are there mental health ramifications of social distancing and isolation, but there have been challenges and barriers for individuals for receiving the care they need. As we look at the convergence of these public health emergencies, it's becoming increasingly clear that overdose-related deaths have been accelerated by the pandemic. There has been an increase, especially in synthetic opioid overdoses, such as from illicitly manufactured fentanyl, since early in the pandemic. An estimated 81,000 drug overdose deaths occurred in the U.S. between June 2019 and May 2020, resulting in the highest number recorded in a 12-month period. During this same period, there was a 38% increase in synthetic opioid overdoses. The CDC, concerned about the rise in overdose deaths, released a health advisory focused on opportunities for health professionals and community partners to support prevention and response activities.

Opioid Abuse and The Healthcare System

The healthcare system has a unique role in the opioid epidemic, beginning with prescription distribution. Healthcare providers have previously been focused on controlling patients' pain and making them more comfortable. The addictive effects of opioids weren't fully understood or appreciated in the past, and the broader impacts became far-reaching. Additionally, legitimate healthcare-prescribed opioids oftentimes serve as a gateway into other drug and opioid usage. Roughly 25% of patients prescribed opioids for chronic pain misuse them, and an estimated 80% of people who use heroin first misused prescription opioids.

The Goal Is Safer Prescribing and Pain Management

The healthcare industry must improve the way clinicians and organizations prescribe opioids and ensure safer, more effective pain management approaches while simultaneously reducing the number of individuals who experience an opioid overdose, opioid use disorder, or other adverse events. There's a growing realization of the need for opioid stewardship, a term being used more frequently, that is often described as coordinated interventions designed to improve, monitor, and evaluate the use of opioids to support and protect health. While national guidelines exist for certain aspects of pain management, like chronic pain, many clinicians and healthcare organizations need and seek more guidance and clarity on exactly how to implement guidelines to maximize their impact and improve patient safety.

The National Quality Forum (NQF) and Opioid Stewardship Engagement

When It comes to opioid stewardship, the National Quality Forum (NQF) has a long history of work in substance use and opioids. Recently, NQF convened approximately 40 of its diverse member organizations to participate in an opioid stewardship action team. The action team met for eight months to identify strategies and tactics to help clinicians better manage patients' pain while reducing the risk of opioid addiction. Together, with input from the action team, NQF developed the National Quality Partners (NQP) Playbook: Opioid Stewardship. The playbook is a practical action-oriented resource guide to support healthcare organizations and clinicians who are committed to effective pain management and opioid stewardship. The playbook addresses a gap by sharing information for implementing guidelines and best practices to promote patient safety related to opioid use and prescribing.

The playbook provides essential guidance across various care settings and circumstances. It meets healthcare professionals where they are and includes ideas, strategies, and implementation guidance organized by basic, intermediate, and advanced strategies, allowing end-users to have flexibility in identifying what strategies are right for them at that time, given their own context, priorities, and resources. The playbook identifies seven fundamental actions or pillars of opioid stewardship: leadership commitment and culture, organizational policies, clinical knowledge, expertise and practice, patient and family caregiver education and engagement, tracking, monitoring and reporting, accountability, and community collaboration. These are the foundation for the courses included in the new HealthStream opioid stewardship courseware, which will be discussed in a subsequent blog post.

This blog post is the first of two based on the NQF-HealthStream Webinar, Addressing the Opioid Epidemic: Creating an Effective Opioid Stewardship Program, which featured presenter Meredith Gerland, Senior Director, Quality Innovation, National Quality Forum. NQF is a not-for-profit, non-partisan, membership-based organization that works to catalyze improvements in healthcare. NQF's members include nearly 400 organizations representing every sector of healthcare. Their mission is to be the trusted voice driving measurable health improvements. For the past 20 years, NQF and its members have been at the forefront of advancing health care quality while tackling the health care system's most urgent needs.

Learn more about the NQF Opioid Stewardship Fundamentals online course.

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