Health systems trim opioid prescriptions

A new HealthPartners study showed that it is possible to substantially cut opioid prescriptions, which makes sense because a new Mayo Clinic study showed that patients don't take most of their opioid painkillers anyway.

The findings this week by two influential health care providers in Minnesota offer further evidence of the overprescribing over the past two decades that has resulted in a rapid rise in opioid addictions and overdose deaths.

HealthPartners' clinics reduced the number of opioid pills prescribed by 3.4 million when comparing the 12-month periods ending in July 2016 and July 2017. The decline was due to a variety of strategies, including a default mode in electronic medical records of flagging any prescriptions of 10 or more opioid pills.

The old trigger was 20 pills, and HealthPartners officials thought about going even lower, said Dr. Bret Haake, a HealthPartners neurologist and chief medical officer of Regions Hospital in St. Paul. "It seems to be a sweet spot where people accept the 10 without overriding it."

Excessive opioid prescriptions for recovery from everything from dental work to broken bones have caused a twofold problem, he said. In some cases, people became dependent on opioids for relief, or even addicted. In others, people didn't use their opioids — making their pills ripe for misuse and abuse by others.

Mayo researchers surveyed 1,907 patients after 25 common surgeries and found that 92 percent received opioid prescriptions. Most took around six pills. The study concluded that 63 percent of prescribed pills went unused.

"There are certain surgeries and types of patients who are likely receiving significantly more opioids than needed," said Elizabeth Habermann, lead author of the Mayo study, which was presented this week at the American Surgical Association's annual meeting.

Mayo researchers are trying to tailor opioid guidelines to specific populations, because blanket drug limits can risk overprescribing to some patients and underprescribing to others who legitimately benefit from the painkilling powers of opioids.

Haake agreed about the need for a nuanced approach that accounts for patients' differences. But he also noted that opioid prescriptions increased tenfold over the past 20 years through bad science and persuasive pain marketing.

An expansion of alternative pain management is needed so doctors no longer rely on opioids as their first choice, he said. "If we can take care of their pain differently, we could stop 90 percent of these people from being introduced to opioids."