Taking an OPEN look at the opioid crisis 

Co-directors Jennifer Waljee, M.D., M.P.H., M.S., Michael Englesbe, M.D., Chad Brummett, M.D.

The opioid crisis across the U.S. has reached staggering proportions, causing more than 134 deaths per day.

“Opioid-related deaths and opioid morbidity is a known public health problem that only continues to get worse. It affects individuals in every state and every situation, both rural and urban,” said Chad Brummett, M.D., associate professor of anesthesiology and co-director of the Michigan Opioid Prescribing Engagement Network (OPEN), a Michigan Medicine collaborative that aims to tackle the opioid epidemic.

Brummett is joined in his leadership by Jennifer Waljee, M.D., M.P.H., M.S., and Michael Englesbe, M.D.

A ‘new way of thinking’ 

According to Brummett, as the opioid crisis began to take hold across the country, the majority of work to stem the issue was focused on helping people once they were already dependent or addicted.

“Few researchers had taken a close look at preventative measures, helping limit exposures to opioids before an addiction can take hold,” Brummett said. “We wanted to adopt that new way of thinking.”

Thus, in 2016, Michigan-OPEN was born. The initiative now includes a program manager, three statisticians, research coordinators, community engagement specialists, an implementation team, a regulatory specialist, a data manager, administrative support, postdoctoral fellows, graduate students and undergraduates from across U-M. Outside organizations such as Blue Cross Blue Shield of Michigan (BCBSM) also partner with the program through the unique network of Michigan-based quality collaboratives.

Multi-pronged approach

The first action the OPEN team did was to look closely at individuals who were not using opioids.

“It may seem like an oxymoron to do that, but for most people, the first exposure to opioids is through acute care, surgery or dental work,” Brummett said. “And 80 percent of the people who become addicted are not taking opioids prior to that care.”

Much of OPEN’s work to this point has focused on exposure through surgery — and how patients can be guided safely through such procedures.

“Becoming a new chronic opioid user is the most common complication following a surgery,” Waljee said. “Yet we have found that there is no correlation between patient satisfaction and the number of pills prescribed to treat pain symptoms.”

For example, one of the team’s studies — carried out by Ryan Howard, M.D., who was an M4 medical student at the time and is now a U-M surgery resident — focused on gall bladder surgery. Howard found that reducing the number of opioids prescribed after surgery from 50 to 15 pills resulted in no change to refill rates, pain levels or patient satisfaction.

The team is now gathering data from a statewide surgical collaborative in order to create prescription guidelines for 100 of the most common surgeries, and the recommendations will be updated 2-3 times each year based on new data.

“We believe that these new guidelines will limit the number of opioids being released into the community, while still attending to the postoperative pain needs of patients,” Waljee said. “And that makes it less likely that a patient, family member or friend will become addicted.”

The Michigan-OPEN team.

Other important steps

Michigan-OPEN is utilizing far more than guidelines to assist physicians. The network is also working closely with BCBSM to incentivize surgeons to prescribe differently.

“Sometimes Tylenol or ibuprofen can serve as the same or better options following a procedure,” Englesbe said. “As a result of our research, BCBSM is providing financial incentives to not only have physicians prescribe fewer opioids — sometimes physicians should prescribe no opioids at all.”

Michigan-OPEN has also organized successful drug take-back events across the state. Last spring, the organization collected about 54,000 unused opioids in 27 different Michigan cities. The next event takes place on Oct. 27.

“Only four percent of young people get their opioids from a drug dealer, the vast majority get them from a medicine cabinet in their home,” Brummett said. “So we’re doing our best to remove these unused opioids from the community.”

Looking ahead

As Michigan-OPEN ramps up drug take-back events, they are also focused on improving patient education.

“We want to be able to tell patients, ‘when you come in for follow-up appointments, bring your unused pills and we can destroy them for you,’” Brummett said.

The team is also helping surgeons better prepare people for what sort of pain threshold they should expect following a procedure by talking openly with them about a pain management plan.

“Pain will always be here, and we will always need to assist our patients in dealing with it,” Brummett said. “But there are safer ways to do it than simply prescribing opioids.”

To Brummett, that’s what makes OPEN’s work so gratifying: “We know that this work will take time — but what we do today will have a lasting impact on the opioid epidemic in the years ahead.”