Daily opioid prescription rate in Utah is dropping. What needs to happen moving forward?
Outside Intermountain’s McKay-Dee Hospital in Ogden, local leaders convened on Tuesday to celebrate the significant drop in daily opioid prescriptions.
Numbers from Utah’s Controlled Substance Database indicated that in 2017, there were 7,000 daily opioid prescriptions. By 2022, the number dropped to 5,200, which is a 26% overall reduction.
To commemorate this reduction, a new chandelier was installed in the main lobby of McKay-Dee Hospital. The previous pill bottle chandelier symbolized the 7,000 daily opioid prescriptions and now the new one represents the reduced amount.
“The reduction in daily opioid prescriptions in Utah is a testament to the inspiring work of the health care providers and community partners tackling the opioid crisis,” Michelle Hofmann, executive medical director of clinical services at the Utah Department of Health and Human Services, said.
The changes that Intermountain Health has made resulted in more than 13 million fewer prescriptions of opioid tablets.
“These changes are huge wins for improving patient safety and keeping patients safe from potential addiction, misuse or even unintentional overdose,” Kim Compagni, Intermountain Health assistant vice president for pain management services, said.
Compagni said that Intermountain Health has been able to find “alternative solutions for pain control for patients, including physical therapy, mindfulness training, acupuncture, massage therapy and medical nutrition counseling.”
South Ogden Mayor Russell Porter praised the efforts of local communities in helping to reduce daily opioid prescriptions.
“By addressing community-specific needs and leveraging resources available at the community level, we not only prevent opioid prescription misuse but also ensure the well-being of our residents, exemplifying the power of local coalitions in creating positive and enduring impact,” Porter said.
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The national opioid crisis
This news about Utah reducing daily opioid prescriptions comes as the nation battles an opioid epidemic.
Though Utah’s ranking decreased, there was an overall surge in opioid overdose deaths.
Across the nation, the majority of drug overdose deaths were related to an opioid, according to the Center for Disease Control and Prevention’s numbers. From 2020 to 2021, the number of opioid-involved deaths increased. Since 1999, there has been a steady increase in these kinds of deaths.
Amid the national surge, Utah’s rate of opioid overdose deaths has lowered. In 2012, Utah was ranked second for highest number of opioid overdose deaths and by 2021, that changed to 40th, per the Deseret News.
Hofmann said that while prescription opioid-related deaths have plateaued in Utah, “since 2018, we’ve seen nearly a 500% increase in fentanyl related accidental opioid overdose deaths.”
The cause of the opioid crisis is complex. “Although it is difficult to establish the major drivers of this crisis, experts point toward the influence by pharmaceutical companies, inadequate regulation, overprescribing by the medical profession, and increased use of illegal heroin and synthetic opioids,” an editorial published in The Lancet said.
Synthetic opioids like fentanyl are more potent than other drugs like heroin, according to the U.S. Drug Enforcement Administration. Fentanyl has contributed to the opioid epidemic in recent years.
“In health care, we dose fentanyl in micrograms,” Amanda N. Donald, addiction medicine physician at Northwestern Medicine, said.
“There is no way to know what doses are going around on the street. To patients with a substance use disorder, fentanyl is what has dramatically increased the risk of not just overdose, but also the risk of severe and prolonged withdrawal,” Donald said.
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What in Utah worked to reduce daily opioid prescriptions?
According to Hofmann, the Know Your Script campaign has been effective at reducing the misuse of prescription opioids. This campaign provides information about how patients can talk to their doctors about alternative solutions as well as proper storage of prescriptions.
“You can have a dialogue so that you understand some of the issues when using opioids, how to use opioid prescriptions properly and safely when you bring them home, and then how to store, dispose of them properly,” Hofmann said.
Something else that’s been effective in Utah is prioritizing alternative solutions to opioids. “Our focus in Utah has largely been in trying to reduce opioid prescriptions over time,” Hofmann said. “And to get the opioid prescriptions at the right dose for individuals and then to push alternative ways of managing pain beyond opioids.”
At Intermountain Health, care providers take an individualized approach to figuring out what sorts of alternative solutions would work with each other. “We have pain psychologists who can help our patients to understand how that pain is impacting them and treat it from a behavioral health standpoint.”
Some of these alternatives include receiving medical nutrition counseling, learning different mindfulness techniques and acupuncture.
“Each of these are a tool in the toolbox,” Compagni said. “And it may not just be one. It may need to be a multifaceted approach where a patient may need to have some cognitive behavioral therapy techniques.”
It does not come down to using just one alternative solution, Compagni said. “They also may need to have physical therapy in addition to some nutritional counseling to look at their diet. How’s inflammation impacting their pain? So, it’s not just one tactic or approach.”
“Opioids do have a place in pain management,” Compagni said. Giving after surgery or breaking a bone as a couple examples, she explained that in those instances, using opioids for acute pain on a short-term basis can aid pain relief.
“But the long-term use of opioids, that’s when we really start getting into more harm, more risk for addiction, more risk for many of the other side effects of opioids,” she said.
These alternative solutions have been effective in some cases for chronic pain, according to Compagni. “We’ve been able to take patients who’ve been on chronic opioid use for sometimes 20 years and be able to taper them down to much lower, safer levels or actually even completely off.”
“And they talk about how their lives have improved because they are no longer plagued by some of the side effects from opioids,” she said.
In addition to doctors providing alternative solutions, policy and statewide campaigns have also been effective.
Utah has “doubled down” on harm reduction, Hofmann said. “We have a statewide campaign on fentanyl test strips and distribution of fentanyl test strips throughout our network in the public health system statewide.”
“Utah had one of the highest rates in the nation of accidental prescription opioid overdose deaths,” Hofmann said.
Policymakers in the state saw what was happening and “took it really seriously,” she said. As a result, now whenever licensed opioid prescribers in Utah go to renew their license, they have to also take a specific training.
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Moving forward
Compagni said there are two practical steps that community members can take moving forward.
The first step is to reduce stigma around conversations regarding opioids and opioid use disorder. “These are our loved ones. These are our community, friends, neighbors, loved ones. It impacts all of us. It’s OK to talk about it,” she said.
Compagni also recommended that everyone have naloxone on hand. “Everyone should have it on hand in their first-aid kits because you never know when somebody around could have an opioid overdose and that naloxone could save lives.”
Administered by syringe or nasal spray, naloxone is an opioid overdose reversal drug. A nonprofit organization known as Utah Naloxone has as its mission to increase access to naloxone.
This organization provides free trainings for the community to learn how naloxone works as well as receive a free naloxone kit.
“Naloxone is by no means the cure here, it’s just the strategy to keep people alive. No one can get better if they’re dead, so we have to keep them here,” Dr. Jennifer Plumb, co-founder of Utah Naloxone, said in a previous interview with the Deseret News.
On a state level, Hofmann said she would like to see efforts around harm reduction continue to make further progress on this issue. As every community is different, she believes that honing in on local, community-level solutions will help continue the progress.
“The community partnerships have been so critical between policymakers, health care systems and providers, community-based organizations, community members at large,” she said. “They really are the drivers of the solutions at the local level in their communities.”
Hofmann echoed what Compagni said about naloxone. “Clearly we’ve seen widespread distribution and improvement in access to naloxone. Naloxone does save lives and we need to continue to have that out in our communities.”
There were three actionable steps Hofmann said that Utahns can take to continue the progress seen in the Beehive State.
“Education is key,” Hofmann said, highlighting the Know Your Script campaign. Knowing more information about opioids can help Utahns have conversations with their families and communities about it.
Hofmann again emphasized the importance of makings sure naloxone is accessible. “I think every Utahn should know about naloxone. I’ve heard of individuals who have naloxone in their possession, whether they know of problems within their family or not. And I’ve heard of individuals saving lives on the street, related to having access to naloxone.”
The last step Hofmann said Utahns can take is to talk to their kids.
“We can’t prevent what we don’t talk about. And our children will find a way to explore and to be curious,” she said. “And if we aren’t having those crucial conversations, we’re opening the door for them to be exposed to things that can be very helpful.”
