HAGERSTOWN, Md. — Meritus Health has decreased the amount of opioids prescribed by more than 55% over the past five years in its efforts to locally combat the national epidemic.
Meritus Health in Washington County, Maryland, has dropped the average amount of morphine milligram equivalents (MME) prescribed per encounter across the health system from 1,402 mg in October 2018 to 625 mg in December 2023.
To meet its mission of “Improving the Health of the Community,” Meritus has focused on being better stewards with the prescribing of opioid pain medications for patients and the community, said Dr. Michael Staley, Pharm. D., Executive Director of Quality/Accreditation and Pharmacy Services for the health system.
“It’s an epidemic,” he said of the prevalence of opioid addiction across the country and in Washington County, of which Hagerstown is the county seat. “This didn’t happen just because of illicit drug use. Most of these drugs are only available through licensed providers.”
Staley said Meritus began its efforts to decrease opioid prescriptions in late 2018 into early 2019.
At that time, Meritus created the Pain Management and Opioid Stewardship Committee to get a handle on the problem and create solutions.
While the Centers for Disease Control and Prevention offers guidelines and methodologies to reduce the unnecessary prescribing of opioid medications, it does not offer an exact benchmark of where a healthcare provider or health system should be, Staley said.
“So we said, ‘Let’s drop it by 50%,’” he said. “We did that and more.”
The ability to do that came courtesy of Meritus switching to EPIC, an electronic medical record, in 2018. Before, there was no way to easily see everything that was being prescribed across the health system, which includes Meritus Medical Center and the Meritus Medical Group practices.
EPIC contains all of the data across Meritus which allowed the health system to consolidate the data, make it uniform and have it provided in real time, Staley said.
The committee addressed opioids given to patients while hospitalized in the medical center, but chose to focus more heavily on outpatient prescribing to retail pharmacies. The highest risk for opioid misuse and the potential for addiction lies outside the hospital, where people have access to meds without medical supervision.
The committee developed pain management and opioid prescribing guidelines with an evidence-based approach. For example, for post-surgery patients or those treated in the emergency department, the guidelines call for a certain amount of an opioid or a lower potency opioid to be used, depending on the care provided. Also, there is a high focus on non-opioid pain management treatments that allow for a more holistic approach to pain relief that is safer and just as effective.
Patients with more complex pain needs, when appropriate, are connected with pain management specialists to manage their more challenging needs.
As part of a strategic initiative, Meritus is focusing on discharged patients who may be on more than one opioid, or on an opioid plus other medications, such as benzodiazepines. These combinations of drugs increase the likelihood of addiction and misuse. The goal is to ensure that the prescriptions are appropriate for the needs of the patient and do not put them at risk.
Meritus has also put in place processes that help connect opioid-addicted patients with treatment programs after discharge or leaving the emergency department. The health system also gives at-risk patients free Narcan, which combats the effects of an opioid overdose and helps to save lives.
Related to treatment, the health system in 2023 opened the Meritus Crisis Center, a six-bed inpatient unit that supports the needs of those struggling with addiction. It also opened a Mental Health Walk-In Care facility that provides mental-health services to individuals in need of immediate help, assessment and intervention. Both are located on the Meritus Medical Center campus.
The goal is to only prescribe an opioid when appropriate, Staley said. It’s crucial that prescribers work with their patients to set realistic pain goals and look at all options for pain management and treatment.
“It’s about what the patient needs,” he said.