Researchers and physicians work together to stem the opioid crisis
Research is integral to Kaiser Permanente Southern California’s robust program to reduce opioid prescriptions and overdoses. In fact, scientists in 2 of the Department of Research & Evaluation’s scientific divisions are separately pursuing active studies with multiple clinical partners.
“We are working to provide evidence to … identify the best strategies to tackle this epidemic,” said Rulin Hechter, MD, PhD, a researcher in the Division of Epidemiologic Research. “That includes improving the quality of patient care and increasing patient safety when we prescribe opiates and looking for alternative ways to tackle chronic pain.”
One reason Kaiser Permanente researchers can conduct groundbreaking relevant opioid research is their partnership with front-line clinicians such as Steven Steinberg, MD, the lead physician for Kaiser Permanente Southern California’s controlled substance task force, and Craig Chang, MD, physician in charge of pain management for Kaiser Permanente Panorama City.
Before getting involved with the task force, Dr. Chang had created a dashboard able to closely track opioid prescription and dispensing doses.
“For a select number of patients, opioids have a very critical role in managing chronic pain,” he said. “The major challenge is balancing that need … with the underlying safety issues that come with the therapy.”
The study team harnessed Dr. Chang’s algorithm to calculate a near real-time daily dosage to further their investigations, Dr. Hechter said.
Dr. Hechter is actively working on 3 projects with Dr. Chang, Dr. Steinberg and other physicians to evaluate the effects of:
- Prescription opioid use while also using tranquilizers or gabapentin, which is used to control seizures or nerve pain, on risk of overdose
- Decreasing and discontinuing opioids on risk of overdose among chronic opioid users who are at high dose and whether certain dose-decreasing strategies, for instance how fast the dosage is decreased, are safer
- Chronic prescription opioid use on mortality in patients age 65 years and older.
Adam Sharp, MD, MSc, a researcher in the Division of Health Services Research & Implementation Science, has collaborated with physicians including Patrick Van Winkle, MD, and Ali Ghobadi, MD, of Kaiser Permanente Orange County. They’re focusing on opioid prescribing in the emergency department.
Dr. Sharp, who is also an emergency physician at the Kaiser Permanente Los Angeles Medical Center, published studies in 2018 that:
- Showed that reducing opioids for chronic pain did not affect patients’ satisfaction with care
- Showed that having a standard emergency department opioid policy decreased likely unwarranted opioid prescriptions
- Identified adolescents and young adults at higher risk of being prescribed opioids, which could help inform future interventions to prevent addiction
Dr. Sharp’s work has removed barriers for physicians trying to reduce opioid prescriptions, said Michael Kanter, MD, former medical director of Quality and Clinical Analysis for the Southern California Permanente Medical Group. (Earlier this year, Dr. Kanter became chair and professor for the Department of Clinical Sciences, Kaiser Permanente School of Medicine.) The other studies also have the potential to change practice.
“We’re way ahead of the rest of the country with our holistic integrated approach to opioid prescribing,” Dr. Kanter said, “But our next steps will be determined by the results of the research that is being done now.”
To read the full article, please check out the Department of Research & Evaluation’s 2018 Annual Report.