The healthcare industry is at the center of the opioid epidemic, and a strategic approach across the field can be the key to addressing it, Holly Geyer, MD, Mayo Clinic Arizona's opioid stewardship chair said.
Dr. Geyer spoke with Becker's about opioid stewardship and what Phoenix-based Mayo Clinic Arizona is prioritizing in its initiatives for 2024.
Note: This conversation was edited for clarity and length.
Question: What are you looking forward to this year?
Dr. Holly Geyer: We've got some great initiatives coming up this year. The opioid epidemic has taken a downturn. We've got more than 110,000 drug-related deaths occurring annually, and about 70% to 75% of those are related to opioids. We're seeing that the healthcare arena is really taking center stage when it comes to identifying that population struggling with the opioid use disorder or addiction, as well as managing them and getting them to the treatment services they need. I see much of our focus this year being on that.
Q: Can you talk about some of the top challenges you're anticipating and how you're planning to address those?
HG: We've realized for a long time that no single intervention is going to solve this crisis. What I can say from a healthcare perspective is that we are in the center of this, and the sooner we recognize this as an industry, the sooner we're going to get people the help they need. The reality is that we played a substantial role in driving the opioid crisis, going back to our years of overprescribing, which really tapered off around 2012, and ultimately drove individuals who struggled with the disorder of addiction into the illicit market. That grew substantially. Now what we're seeing is that the vast majority of people who struggle with opioid use disorder are oftentimes either going to this illicit market to obtain the drug or being started on medications, oftentimes inappropriately by us, and then ultimately succumbing to the condition of addiction.
In either case there is a role for opioid stewardship. That's where I think we as the healthcare industry need to go. So the challenges for us are buy-in. The data shows that less than 23% of U.S. healthcare institutions have an active opioid stewardship program, according to a study just done a couple of years ago. There's tremendous opportunity for us to enhance how we identify the populations that would benefit from opioids, how we pair those opioids with the right alternatives, or use those alternatives as first line as opposed to going straight to opioids and then how we manage those struggling with opioid related complications.
Q: And are there any particular projects that you're working on right now that you can talk about that are working towards all this?
HG: Much of our initial opioid stewardship program initiatives focused around making sure we're prescribing opioids, right. But as we've seen the illicit market grow, it's become quite clear that if we're not managing those struggling with addiction, then ultimately they just become revolving parts of the cycle of addiction. The data shows that individuals who struggle with addiction are using the ER 12 times more often than the person without it, and have eight times the health care costs incurred. The impact on us as Mayo Clinic can be substantial, and other large health care or small healthcare systems probably feel the same. The sooner we address it, the sooner it gets better. Our initiatives this year will be making sure that people are identified early. We've built into our EMR identification tools and regular screening protocols, both inpatient and outpatient, to assist with this. On top of that, we've built out a referral network for individuals who might benefit from initiation of medications for opioid use disorder, primarily buprenorphine, oftentimes starting it within the inpatient and or outpatient environment to do so and then making sure that individuals are receiving comprehensive treatment. That's the biopsychosocial spiritual treatment model, which essentially means working towards getting the whole person back. I can tell you one thing that's a great misunderstanding in our industry, and that abstinence is the ultimate goal of treatment. Abstinence is a part of treatment recovery. That whole person recovery is really what we want to target, and we can't do that without strategic partnerships in the community.
Q: Are there any interesting partnerships going on right now that you're excited about or any partnerships that you're eyeing whether in Arizona or nationwide?
HG: We partnered with a number of large organizations that are dealing with the epidemic. We work closely with the American Hospital Association. We've got representatives within the American Society of Addiction Medicine serving on some of our committees. And so we've really tried to broaden our length with other organizations tackling the epidemic. When it comes to developing community partnerships, it's really key that we're surveying them to make sure that they meet all those standards of care. A recent study that came out in November shows that when we refer a person with opioid addiction out to a program that doesn't offer the medications for opioid use disorder, we increase their mortality rate by 77% just when they enter the program. That means that they were living under a bridge and unfortunately shooting up fentanyl, they probably had a better life expectancy than if we had referred them to a program that doesn't offer standard of care. I would recommend reviewing these programs to make sure that they offer comprehensive treatments and or consider initiating the opioid stewardship program process that begins those medications for abuse disorder in house.
Q: I wanted to hone in on the word "stewardship." Can you talk about why you call it that as opposed to opioid care or healing?
HG: The concept of stewardship goes back thousands of years. It's taking care of what's in your possession. When we think about what is our most precious possession in the healthcare industry, it's our patients. So really we are facilitators of the treatment protocols, the processes, the workflows that get those patients the care they need. When it comes to the concept of opioid stewardship, what we're really talking about there is making sure that the right patient gets the right medication, at the right dose, for the right length of treatment, with the right number of refills if needed, and then is referred to the right resources as necessary for complications.
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