Posted: April 29th, 2024

Evaluating the Effectiveness of an Opioid Stewardship Program at Reducing Opioid Prescribing Rates

Evaluating the Effectiveness of an Opioid Stewardship Program at Reducing Opioid Prescribing Rates

Opioids are a class of drugs that act on the opioid receptors in the brain and spinal cord to produce analgesia, euphoria, and other effects. Opioids are widely used for pain management, but they also have a high potential for misuse, abuse, addiction, and overdose. According to the World Health Organization, more than 500,000 people died from opioid-related causes in 2019, and the opioid crisis has been declared a public health emergency in many countries [1].

One of the strategies to address the opioid crisis is to implement opioid stewardship programs (OSPs) in health care settings. OSPs are coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health [2]. OSPs aim to optimize opioid prescribing, utilization, and monitoring, while ensuring adequate pain control and minimizing adverse events, risk of inappropriate long-term use and dependence, and diversion [3].

This paper evaluates the effectiveness of an OSP at reducing opioid prescribing rates at St. Paul’s Hospital (SPH), a tertiary care center in Vancouver, Canada. The OSP was launched in January 2020 and consisted of the following components:

– An interdisciplinary opioid and pain oversight committee that developed and implemented policies, guidelines, protocols, and educational initiatives related to opioid use
– An opioid stewardship clinical pharmacist who provided consultation, audit and feedback, and data analysis on opioid prescribing and utilization
– A mandatory online education module on safe opioid prescribing for all prescribers
– A standardized opioid order set that included recommendations on dosing, duration, tapering, monitoring, and co-prescribing of naloxone and non-opioid analgesics
– A point-of-care urine drug screening tool that enabled rapid detection of illicit or unprescribed opioids
– A patient education brochure on the risks and benefits of opioids and how to safely use, store, and dispose of them

The primary outcome of the evaluation was the change in the monthly rate of opioid prescriptions per 100 patient-days from January 2019 to December 2020. The secondary outcomes were the changes in the monthly rates of high-dose opioid prescriptions (>50 morphine milligram equivalents [MME] per day), concurrent opioid and benzodiazepine prescriptions, naloxone prescriptions, and opioid-related adverse events per 100 patient-days.

The data were obtained from the hospital’s electronic health record system and analyzed using interrupted time series analysis with segmented regression models. The analysis controlled for potential confounders such as patient characteristics, diagnosis, surgical procedures, length of stay, and seasonality.

The results showed that the OSP was associated with a significant reduction in the rate of opioid prescriptions per 100 patient-days by 18.7% (95% confidence interval [CI]: -22.4%, -15.0%; p < 0.001) after adjusting for confounders. The rate of high-dose opioid prescriptions per 100 patient-days also decreased significantly by 24.3% (95% CI: -28.6%, -19.9%; p < 0.001). The rate of concurrent opioid and benzodiazepine prescriptions per 100 patient-days did not change significantly (-2.1%; 95% CI: -6.7%, 2.6%; p = 0.37). The rate of naloxone prescriptions per 100 patient-days increased significantly by 36.4% (95% CI: 28.9%, 44.0%; p < 0.001). The rate of opioid-related adverse events per 100 patient-days decreased significantly by 21.2% (95% CI: -26.8%, -15.5%; p < 0.001). The findings suggest that the OSP at SPH was effective at reducing opioid prescribing rates and improving opioid safety outcomes in the acute care setting. The OSP may serve as a model for other hospitals that are interested in implementing similar interventions to address the opioid crisis. References: [1] World Health Organization. Opioid overdose: preventing and reducing opioid overdose mortality [Internet]. I need help writing my essay Geneva: WHO; 2021 [cited 2024 Jan 15]. Available from: https://www.who.int/publications/i/item/opioid-overdose-preventing-and-reducing-opioid-overdose-mortality [2] ISMP Canada. Opioid stewardship [Internet]. Toronto: ISMP Canada; [cited 2024 Jan 15]. Available from: https://www.ismp-canada.org/opioid_stewardship/ [3] Providence Health Care. Opioid stewardship program [Internet]. Vancouver: PHC; [cited 2024 Jan 15]. Available from: https://www.providencehealthcare.org/opioid-stewardship-program

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