Moving beyond opioids: A new era in pain management

Sameer Awsare, MD, associate executive director, The Permanente Medical Group 

Opioid addiction decimates tens of thousands of individuals, families, and communities each year. Across the country, around 200 people die of opioid overdoses every day.

This June, after years of little progress, the Centers for Disease Control and Prevention reported opioid overdose deaths had dropped by 16.6% over the previous year. The decline suggests strategies to combat and reduce opioid misuse — including opioid deprescription, alternative pain management, and public health campaigns — are making a difference.

From pharmacists to physicians, nurses, social workers and hospital administrators, everyone in health care must do their part to reduce opioid overdose. Physician leaders, in particular, are responsible for creating an evidence-based, appropriate, and effective pain management approach for their entire health system. 

Related opioids pain management podcast: Pain points: Navigating the opioid crisis 

Why value-based care improves pain management

 At Kaiser Permanente, we made it our goal to reduce opioid misuse, overdoses, and deaths within our value-based health care system through an evidence-based, patient-centered approach. Physician leaders developed a fundamentally different pain management model that emphasizes comprehensive pain management, including alternatives to opioids. The model’s four-pronged approach focuses on:

• Physician education and support. This encompasses the latest in clinical pain management education, as well as integrated care coordination and data analysis. Our computer-based prescribing systems include opioid safety alerts, which suggest preferred and maximum opioid doses and avoid dangerous medication combinations. We also offer links to evidence-based guidelines and alert physicians when a patient might be receiving opioids from physicians outside of Kaiser Permanente’s health care system.

• Patient education. When patients do need opioids, they complete a medication agreement with their physician after discussing risks, benefits, and alternative options. Members can also access in-person and online opioid resources.

• Patient safety. Clinicians provide effective pain management alternatives that may include cognitive behavioral therapy, group classes on pain management, mindfulness training, and Tai Chi or acupuncture. We also provide naloxone to patients and their caregivers to counteract accidental overdoses for patients using medically prescribed opioids used to treat chronic pain, which is pain that lasts more than three months.

• Community protection measures. These measures include several key initiatives. First, reduced prescribing to decrease the total quantity of opioids in the community. Second, increased access to medication take-back bins in our pharmacies. Third, strategic community partnerships to improve opioid safety. Finally, collaborations with government, academic, and non-profit organizations to promote opioid safety best practices.

Related opioid crisis story: Health, community experts discuss fentanyl crisis in The Permanente Journal 

How coordinated, patient-centered care can reduce opioid prescribing

Kaiser Permanente’s model works because care is well-coordinated among primary care physicians, specialists, pharmacists, and other health care professionals using electronic health records. This coordination helps break down silos and ensures the most up-to-date information about each patient is shared with their entire care team. Internal data demonstrates the power of our patient-centered approach to care. Between 2014 and 2023, The Permanente Medical Group in Northern California showed a 79% drop in the overall volume of opioids prescribed and a more than 40% reduction in high-dose opioid prescribing between 2022 and 2023.

A 16.6% national reduction in overdose deaths over the course of a year is worthy of celebration, but even with that reduction, opioid overdoses still steal nearly 100,000 lives annually. At Kaiser Permanente, we are both doing our part and sharing our learnings with other health systems working towards a safer, more sustainable future in health care — one where patient safety and quality of life are at the forefront of every decision.

Dr. Sameer Awsare is an associate executive director for The Permanente Medical Group. He oversees pharmacy, adult and family medicine, and opioid initiatives, among other operations.