Vim & Vigor - Spring 2018 - University of Virginia - 7

OPIOID
A
DDICTION

See how UVA is tackling the opioid
crisis on multiple fronts BY HOLLY FORD

F

or more Americans, the
opioid crisis is hitting close
to home. Now considered a
national emergency, opioid
addiction is impacting all regions of
the country, all races and all classes; no
community is immune to this tragedy.
How bad is it? The death toll from
overdoses of prescription and illicit opiates such as heroin topped 33,000 in
the United States in 2015, according
to the Centers for Disease Control and
Prevention. That's nearly 100 deaths
every day, three per day in Virginia
alone. Hospitalizations due to misuse of
these drugs have increased by 64 percent since 2005. "The numbers are staggering, and they're going in the wrong
direction," says University of Virginia
Health System infectious disease specialist Kathleen McManus, MD.
So how do we turn the tide?
Overcoming this challenge will require
the sustained, collaborative efforts
of many-from policymakers in the
federal government to care providers and patients themselves, according to a study chaired by UVA School
of Law professor Richard Bonnie for
the National Academies of Sciences,
Engineering and Medicine.
One important factor is prescribing these highly addictive drugs safely
and responsibly.
UVA researchers and physicians
have been informing the debate on a

national level. But their work began at
home with a deep dive into UVA Health
System's own protocols for managing
opioids and how we can help alleviate
this crisis across the Commonwealth
and beyond.

HERE ARE KEY STEPS
THAT ARE MAKING AN
IMPACT AT UVA.
Fostering OVERSIGHT

UVA Health System rebuilt its electronic
medical record system to include stopgaps that prompt physicians to select
alternative pain medications and limit
the number of opioid pills that can be
prescribed at one time, explains UVA
Chief of Quality and Performance
Improvement Tracey Hoke, MD. UVA
also trained hundreds of physicians on
new regulations issued by the government in 2016 to help providers prescribe
opioids appropriately.

Using ALTERNATIVES

Recent research has shown that opioids
may not be the best option for patients
undergoing surgery. "Over the last few
years, it's become obvious that there
are many negative side effects of opioids in addition to the potential for
abuse," says UVA colorectal surgeon
Traci Hedrick, MD. They may cause
delirium, nausea, vomiting and gastrointestinal issues such as constipation,

which can lead to delayed recovery and
more days in the hospital.
In response to these findings, UVA
implemented Enhanced Recovery After
Surgery (ERAS), which includes many
process improvements aimed at helping patients recover sooner. One of the
primary goals of ERAS is to limit opioid
use and implement alternative strategies for managing pain. So instead of
opioids, patients having elective GI,
gynecologic, thoracic or pancreatic surgery now receive a combination of other
drugs, such as anti-inflammatories and
local anesthesia.
"We have been able to reduce our
use of opioids by 80 percent," says
Dr. Hedrick. Plus, patients are leaving the hospital an average of two days
sooner after surgery, and they report
less pain. These successful outcomes
have prompted the planned expansion
of ERAS throughout UVA surgical specialties. They have also attracted other
hospitals to the program, so UVA is
involved in helping these sites implement ERAS as well.

Prescribing Opioids
SAFELY

Although it may seem that the easy way
out of this crisis is to stop prescribing
these drugs (such as Vicodin and
oxycodone) altogether, palliative care
physician Leslie Blackhall, MD, cautions that some patients would suffer
as a result. "Cancer patients are the
only individuals for which opioids are
truly helpful," she says. "It would be
great if we had other options, but we
don't always have them."
SPRING 2018

7



Table of Contents for the Digital Edition of Vim & Vigor - Spring 2018 - University of Virginia

Contents
Vim & Vigor - Spring 2018 - University of Virginia - Cover1
Vim & Vigor - Spring 2018 - University of Virginia - Cover2
Vim & Vigor - Spring 2018 - University of Virginia - Contents
Vim & Vigor - Spring 2018 - University of Virginia - 2
Vim & Vigor - Spring 2018 - University of Virginia - 3
Vim & Vigor - Spring 2018 - University of Virginia - 4
Vim & Vigor - Spring 2018 - University of Virginia - 5
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Vim & Vigor - Spring 2018 - University of Virginia - Cover3
Vim & Vigor - Spring 2018 - University of Virginia - Cover4
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