Impact of a health system's three-pronged strategy to address the opioid epidemic

News Release: 27-May-2020

This article by Dr. Oralia Dominic et al. is published as open access in The Open Public Health Journal, Volume 13, 2020

United States has been facing a serious problem of drug abuse and addiction, and has seen around 700,000 deaths within a span of 20 years (1999 to 2017) due to drug overdose. Opioid abuse, among other drugs, has been a prime cause of deaths due to overdose and misuse. In order to control this opioid epidemic, Highmark Inc., a national health plan and the second largest integrated delivery and financing system in USA devised, implemented and assessed a series of quality management-focused opioid interventions with the help of a three-pronged public health strategy.

Dr. Oralia Dominic, the Chief Medical Officer (CMO), Highmark Inc., Pittsburgh, PA, USA, defined the three-pronged public health strategy that was implemented in Delaware, Pennsylvania, and West Virginia, to curtail the use and abuse of opioid. The strategy was designed with the following objectives.

1) The first and foremost objective has been to manage pain more effectively in order to reduce the need for opioids (primary prevention)

2) Secondly, when required, prescription of opioids should be according to safe prescribing guidelines (secondary prevention)

3) Lastly, to ensure access to effective treatment for the ones with Opioid Use Disorder (OUD) to help reduce morbidity / mortality through opioid abuse (tertiary prevention)

Dr. Dominic and the team engaged in this healthcare plan deployed a series of evidence-based and data-driven interventions with the help of clinical guidelines, integrated and coordinated infrastructures, and community-based participatory research frameworks within the service areas in the three states of USA. Through thorough primary and secondary research utilizing all the data available and collected, the strategy was implemented and evaluated to assess the success of the interventions.

The results of this three-pronged opioid intervention strategy, during the period of 2013 to 2017, have been promising, as there has been a significant decrease of 19% of opioid use as prescription drug. A decrease in the duration of opioid use (number of days of opioid use) was observed. The plan also helped reduce the number of members on higher strength 20+ MME (Morphine Milligram Equivalents) opioids.

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