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Changing Opioid Culture

AnismanUtah is among a handful of states that has seen a marked increase since 2000 in deaths of despair—so-called because of their link to suicide, drugs, and alcohol. Opioid overdoses are among the main offenders; some counties in Utah have more opioid prescriptions than they have people. While many physicians at U of U Health are tackling the problem in a centralized way—notably, the taskforce led by pediatrician Karen Buchi—there are others doing the day-to-day work of transforming the way they and their peers think about opioid prescribing practices. For example, the surgery department designed a strategy that includes a mix of system reform (changing how and when opioids are prescribed) and patient education (using patient decision aids).

David Anisman, a Community Physician Group doctor, created a program to help providers navigate the complex task of evaluating and treating chronic pain in the context of a busy primary care practice. The goal is to decrease high-risk opioid prescribing while promoting safe, effective prescribing. Providers perform a thorough pain evaluation, assess opioid risk, and make sound decisions about when to prescribe opioids. When opioids aren’t appropriate, the program encourages providers “to say no with empathy,” Anisman said. The program’s tools include easily created, formatted notes, EMR-embedded functional assessments, drug screening, and the state’s controlled substance database.