Providers at Sanford Health have reduced opioid prescriptions by nearly 20 percent over the past year in an effort to have fewer pills in circulation.
In 2016, the health system based in the upper Midwest took a hard look at how providers talked to patients and how they wrote prescriptions and looked for ways to make changes. It included collecting prescribing data from every provider and comparing within specialties to look for outliers.
But it was more than a numbers game – it was a change in perspective to respond to a growing national opioid crisis. The health system instituted mandatory physician education programs and also stopped asking patients about pain as a vital sign.
That, combined with writing smaller prescriptions for things like acute injuries or stopping using opioids for conditions where they aren’t proven effective, like headaches and low back pain, helped reduce overall numbers, too.
“I don’t think we were intentionally overprescribing,” said Doug Griffin, M.D., chief medical officer of Sanford Health in Fargo, North Dakota. “It was just a habit we got into.”
40 percent drop possible
Since the first quarter of 2016, the system has cut the number of prescriptions by 18 percent and the number of total tablets prescribed by 24 percent, excluding cancer patients. By region, Fargo saw the greatest drop, with a 25 percent reduction in prescriptions and a 33 percent drop in tablets.
“One of the discussions we’ve had is what our target should be for dropping,” Griffin said. “Personally, I think it would not be out of our reach to get to a 40 percent drop.”
Allison Suttle, M.D., chief medical officer for Sanford Health in Sioux Falls, said systems across the country are wrestling with the same question.
“Our approach is when we recognize there’s a problem, we just start going after it,” Suttle said. “What amount of prescribing is the right amount of prescribing?”
The collection and comparing of data can also help providers who may not realize their patterns.
“We can generate reports and find those providers who are getting in trouble before the DEA (Drug Enforcement Administration) comes knocking,” Suttle said. “These physicians feel like they are doing good. The patients are so grateful.”
Griffin agreed the physician response has been positive.
“I think there was a bit of relief,” he said. “A lot of physicians get put into difficult situations that can be tough to manage. So I think many doctors are relieved that the organization is behind them and can give them some tools to wean these patients off these medications.”
Prescriptions by specialty
When they looked at which specialties prescribed the most by tablet, it was primary care, family medicine and internal medicine. Part of that is straight volume – there are more of them than other areas – and part is because of the largely rural footprint for Sanford Health. In some communities, those are the only physicians practicing.
By prescription, emergency departments and urgent cares gave out the most, but with a lower tablet count.
“I’m pretty confident we’re doing a good job in our emergency departments and urgent cares not prescribing inappropriately, and only giving small amounts for the short-term,” Griffin said.
Suttle agrees and said the goals are to keep patients from becoming addicted and to make sure there are fewer pills in circulation to be abused.
“What came first, the chicken or the egg,” she said. “We have grown up in an era where you take away pain 100 percent. The drug manufacturers own what they did, and the providers own what we did.”
Griffin believes there’s still room for progress.
“We need to find that sweet spot, because there are some people who benefit and have been responsibly prescribed these medications,” he said. “I don’t think we’ll ever get to zero.”
By the numbers: Sanford Health opioid prescriptions
Region % reduction in tablets % reduction in scripts
Fargo 33 percent 25 percent
Sioux Falls 19 percent 11 percent
Bismarck 11 percent 14 percent
Bemidji 37 percent 24 percent
Total: 24 percent 18 percent
Source: Sanford Health