Northwell, Mayo Clinic tackle painkiller epidemic

By GREGORY ZELLER //

Northwell Health will join the Mayo Clinic and one of the nation’s largest medical schools on a three-year study targeting painkiller addictions.

Citing “a growing epidemic of opioid abuse,” the New Hyde Park-based health system announced this week a $350,000 stipend over three years from the nonprofit Washington-based Patient Centered Outcome Research Institute to fund a collaborative study designed to track painkiller dependency among ER patients, and ultimately lower the risk.

Led by emergency department physician Karin Rhodes, Northwell Health’s vice president of care management design and evaluation, the “Comparative Effectiveness of Probabilistic vs. Patient Narrative-Enhanced Risk Communication for Pain Management Following Acute Care” study will involve researchers on Long Island, at the Minnesota-based Mayo Clinic and at UPenn’s Perelman School of Medicine.

Karin Rhodes: Mitigation through education.

Karin Rhodes: Mitigation through education.

It’s slated to enroll 1,200 total patients, 400 for each research group, who arrive in emergency departments with pain from kidney stones or lower-back ailments. Patients suffering these conditions are traditionally prescribed opioids such as oxycodone, hydrocodone, codeine and morphine for pain relief.

But anti-inflammatory, non-steroidal medications – aspirin and ibuprofen are two examples – have “been shown to work equally well for pain management,” according to Northwell Health, and Rhodes and her colleagues are planning a large-scale educational intervention.

Their mission: to track patient pain levels and recoveries on and off opioids while potentially stemming the global opioid-abuse tide. According to the National Institutes on Drug Abuse, as many as 36 million people abuse opioids worldwide, with more than 2.1 million people in the United States suffering substance-use disorders related to prescription opioid pain relievers – as of 2012, nearly five times the total number of people addicted to heroin.

That opioid/heroin door swings both ways. The American Society of Addiction Medicine notes that 23 percent of all heroin users ultimately develop opioid addictions, part of a drug-overdose scourge that was the leading cause of accidental U.S. deaths in 2014, with 47,055 lethal drug overdoses recorded – 18,893 of which were related to prescription pain relievers.

“Patients can easily become dependent on [opioids] without realizing it,” Rhodes noted. “We want to see whether people who understand the risk, and in particular their risk, will be less likely to choose an opioid as a pain reliever.”

Careful to balance what the ER physician called “good pain management” and “informed decision-making,” the research teams will attempt to engage qualified emergency-department patients in two distinct ways. The first involves a questionnaire designed to assess a patient’s personal opioid-addiction risk level, touching on red-flag factors including individual or family history of drug or alcohol abuse.

The questionnaire also includes a chart that visibly shows patients where they place on the potential opioid-dependency spectrum.

The second engagement method involves the same questionnaire and chart accompanied by a videotaped narrative from a patient who lapsed into opioid addiction following an emergency pain prescription.

Rhodes, who noted “people learn by stories,” said the study was actually inspired by the cautionary tale of a nurse who became addicted after being treated for a minor injury with opioids in the UPenn emergency department.

“He began stealing drugs from work and his life spiraled out of control, until he ultimately sought treatment and recovered,” Rhodes added. “He wanted to share his story and make sure others are warned of the risks.”

After engaging ER patients through one of the two methods, the research teams will track whether participants and their emergency-department providers choose prescription opioids or anti-inflammatory, non-steroidal medications upon hospital discharge.

Patients will be asked to respond to daily text messages for one week to discuss their medication use and pain levels, followed by three months of weekly messages discussing pain, medication, resumption of work and personal activities and other recovery factors.

After three months, the patients’ pain management and functionality will be re-assessed, and after three years of such studies, the data gathered from the two intervention methods will be compared.

Based on pilot data, the study’s hypothesis is that patients exposed to the videotaped narratives will take fewer opioid doses over fewer days. Rhodes “would also not be surprised if they return to work sooner,” the doctor noted, “as you cannot drive to work if you are on opioids.”

Referencing studies that show nearly half of all ER visits are pain-related, Rhodes said the emergency-department study is particularly important in an era when patient-satisfaction surveys directly influence hospital operations – and pain management is a direct influencer of patient satisfaction, creating what Rhodes called “tremendous pressure for providers to prescribe opioids.”

“Patients must be informed about the risks around opioid use,” the ER physician said. “Individualized prevention may be the key to addressing the opioid epidemic.”