In response to rising rates of opiate addiction across the state of Ohio, Governor John Kasich established the Ohio Governor’s Cabinet Opiate Action Team (GCOAT) in 2011. With involvement from Prevention Bureau Chief/NPN Molly Stone and others from the Ohio Department of Mental Health and Addiction Services (a Partnerships for Success 2014 grantee), the team was charged with reducing opiate addiction rates and overdose deaths across the state. Understanding the role of opioid over-prescribing as a key contributor to subsequent addiction and overdose,1 GCOAT focused its efforts on developing opioid prescribing guidelines.
To inform guideline development, GCOAT convened a 75-member task force comprising prevention professionals, doctors, dentists, nurses, and other healthcare providers. Together, the team created three sets of guidelines: to inform opioid prescriptions for emergency medicine, for chronic care management, and for acute care settings.
Within two years, the task force produced the emergency medicine and chronic care prescribing guidelines. According to Andrea Boxill, Deputy Director of GCOAT, the process for developing these initial sets went relatively smoothly. “There was quick consensus on what do in the emergency room—don’t send people home with a script for 30 pain pills for a sprained ankle, for example. And it was easy to create thoughtful guidelines for people in chronic pain,” she explains.
Yet when the group turned its efforts toward developing acute care guidelines, the road proved bumpier. Boxill describes the tension: “So much of acute care hits at the heart of how a physician practices medicine. Telling a doctor what they should be doing gets at something very personal. They are resistant to any suggestion that they are doing something wrong.”
Fortunately, the group was able to draw on the solid foundation established by Boxill and others to work through their challenges. “Our focus was to acknowledge and honor concerns respectfully, but to keep the work moving forward,” says Boxill. In early 2016, GCOAT released the final set of prescribing guidelines. While data regarding their efficacy is still being collected, initial reports suggest that they are being well-received.