How Cleveland Clinic is Dealing With The Opioid Epidemic

It’s an unfortunate reality that Ohio leads the nation in opioid-related emergency room visits. In 2016, Cleveland Clinic alone had more than 2,300 opioid-related ED visits, including 1,200 overdoses. It’s important to note that healthcare bears some responsibility. Over 75% of opioid addictions begin with a prescription. We’re committed to alternative ways to treat pain.

Read Dr. Cosgrove’s op-ed: Healthcare Providers Helped Bring About the Opioid Epidemic; Now It’s Time to End It

Pharmacy, prescribing and company wide programs

  • Cleveland Clinic offers communication training courses for physicians that teach how to decline opioid requests from patients with an emphasis on compassion.
  • We follow state guidelines on opioid prescriptions for acute pain — seven days for adults and five days for children. Any prescription beyond the state guideline must have documentation from the prescriber in order to be filled.
  • Cleveland Clinic hired a full-time Doctor of Pharmacy specializing in pain to improve prescribing practices and clinical care.
  • Nurses have designated pain champions on every unit who are conversant with alternative pain strategies.
  • We helped successfully lobby the Center for Medicare and Medicaid services to remove the pain question from patient experience surveys tied to reimbursement.
  • Cleveland Clinic implements random employee drug testing within the organization.

Addiction and recovery series 

  • We offer a 16-bed inpatient detox unit that also includes therapy and psychiatric treatment, with more than 1,200 admissions per year.
  • Three intensive outpatient programs (IOPs) treat more than 5,000 patients each year.
  • One partial hospitalization program (PHP) treats 1,500 patients each year.
  • We’ve seen roughly 6,500 outpatient clinic visits (ranging from therapy to medication management) each year.
  • Cleveland Clinic offers free after-hours support groups for program graduates.

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Clinical examples to prevent addiction and opioid use

Getting Back on TREK:
Back pain strikes about 31 million Americans at some point during their lives. All too often, the first-line treatment is surgery or pain killers. At Cleveland Clinic, we are offering a different approach. Back on TREK (Transform Restore Empower Knowledge) is a pilot program treating patients with chronic low back pain (with or without leg pain), with the goal of restoring function through non-surgical treatment approaches and providing patients with tools to manage their pain without opioids.

The program utilizes a combined treatment approach of psychologically informed physical therapy; pain neuroscience education and behavioral medicine sessions utilizing cognitive behavioral therapy and psychological education techniques. More than 60 percent of patients showed significant improvement in pain and disability; over half demonstrated significant reduction in fatigue, pain interference, and overall physical health.

Addiction during pregnancy:
Half of all pregnancies in the United States are unintended. Many women who find themselves unexpectedly pregnant suffer from substance disorders. The Cleveland Clinic has seen an increase of women year over year with substance disorders. We have launched an opioid use disorder team where general OB’s, maternal fetal medicine OB’s, midwives, nurses and social workers are all trained to identify these women. They help with withdrawal management and support them throughout pregnancy. Our goal is to screen all patients, find those at high risk and get them into a medication-assisted treatment program during pregnancy to co-manage them during pregnancy and continue to guide them postpartum.

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Painless mastectomy: This is an experimental medication we are studying. It’s local anesthesia medicine released over time after mastectomy followed by breast reconstruction to help patients with the worst of the pain—within the first four days post-surgery—so patients don’t rely on pain medicine to get through that period. It’s a long-lasting drug that is encased in a liposome and slowly released. The medicine provides pain control and potentially enables faster recovery while reducing opioid use.

Opioid-free colorectal surgery: We treated about 80 patients undergoing colorectal cancer surgery in 2016 at Cleveland Clinic Akron General. In 1/3 of the cases, no opioids were used. Beyond reducing use of opioids, the other benefits include lower risk of complications, shorter hospital stays (by about 50%), decreased surgical costs and lower readmission rates. After this surgery, patients are leaving the hospital in an average of 2.3 days compared to 2.7 days previously.

ERAS (Enhanced Recovery After Surgery): Recently, comprehensive research has indicated that an ERAS methodology that permits patients to eat before surgery, limits opioids by prescribing alternate medications and encourages regular walking reduces complication rates and accelerates recovery after surgery. ERAS can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more. Patients are also given a post-operative nutrition plan to accelerate recovery, and physicians are using multi-modal analgesia, limiting the use of opioids. The Cleveland Clinic and other health centers are using this program.

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