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SALT LAKE CITY — Intermountain Healthcare announced Tuesday that its hospitals and clinics will commit to trying to reduce the number of opioid tablets prescribed for acute pain by 40 percent by the end of 2018.
"We overprescribe (opioids) to some degree, the truth of it is," said Dr. Todd Allen, director of Intermountain Healthcare's emergency departments and the organization's chief quality officer.
Intermountain said in a release that it is "the first U.S. health system to formally announce such a significant and specific amount of reduction as a target."
The need for a reduction is urgent in Utah, where about 7,000 prescriptions for opioid painkillers are issued per day on average, Allen said.
Too often, he said, well-meaning doctors intending to be thorough end up recommending a number of pills greatly exceeding what is strictly necessary for pain treatment.
"That happens again and again," Allen said.
On average, 91 Americans die per day from opioid overdoses, including an average of two Utahns per day. Allen said 85 percent of heroin addicts' addictions to the drug began with prescription opioids, meaning the life crisis can commonly be traced back to a doctor visit.
"Currently, nationwide, providers tend to write prescriptions for more opioids than patients need, and large quantities of the medications are often left over after the need for pain relief is past," Dr. Doug Smith, associate medical director at Intermountain Healthcare, said in a statement. "We will follow best practices in prescribing so the medications more closely match the needs of patients."
Data suggests Intermountain Health Care's 22 hospitals and 180 clinics prescribe about 19 million opioid tablets per year, said Lisa Nichols, director of community health partnerships for Intermountain.
Of those, more than 12 million are prescribed in response to cases of acute pain, Nichols explained. The 40 percent reduction goal means Intermountain is hopeful it can cut back by more than 5 million prescribed pills, she said.
The goal to reduce opioid prescriptions is not focused on cutting back numbers of tablets given out for serious chronic illnesses such as cancer, for which major prescription reductions are not as realistic, Nichols said.
Several practices are being put in place at Intermountain to successfully cut back acute pain prescription numbers, Allen said. Those include meticulous tracking of caregivers' prescription habits, with "relatively real-time" data available within the organization, he said.
"My prescription habits should be available with a click or two," Allen said.
He said in some cases, it boils down to having frank, unabashed conversations with patients about why an opioid prescription is not the best option for them, or why a prescription is more limited than others have been in the past.
"We're trying to train everybody to have those important conversations. ... Me and my colleagues are not going to be timid anymore," Allen said.
About 2,500 caregivers have already received training on how to step down the number of tablets they prescribe, according to Intermountain's release.
Other alternatives to an opioid prescription can include recommendations for physical rehabilitation and "more holistic therapies," as well as referral to pain management clinics, Allen said. He added that those tools have been underutilized in doctors' efforts to treat pain.
"Unless we're surrounded by this other stuff, we're ultimately going to fall short," he said.
We will follow best practices in prescribing so the medications more closely match the needs of patients.
–Dr. Doug Smith, associate medical director at Intermountain Healthcare.
Asked whether patients are supportive of Intermountain's plans for opioid prescription reduction, Allen said "they remarkably are." Many patients have told doctors, "thank you for bringing that up," citing stories of addiction within their own families, he said.
The goal of reducing opioid prescriptions by 40 percent is ambitious, Allen said, but is soundly data-based and can be achieved if Intermountain invests in a "culture of accountability."
"I like it because it's aggressive," he said.
Nichols echoed Allen's hopefulness. She said that while she has not seen any similarly specific commitment from other American hospital systems, initiatives such as the one introduced Tuesday are likely to become more common.
"There's a growing awareness of how serious this problem is," she said. "I think it is on the horizon."
Nichols said another major initiative at Intermountain is the drive to motivate Utahns to get rid of their leftover painkillers. About two-thirds of misused opioids belonged to family members or friends of the people taking them, according to studies cited by Intermountain Healthcare.
"The tablets live in our bathrooms, in our ... cabinets," Allen said. "That's where it starts."
More than 15,000 pounds of unused medications have been safely discarded at drop boxes that Intermountain installed at its pharmacies in 2015.
"We really want to support (people) in disposing of those safely," Nichols said.