Over the six years of its opioid stewardship initiative, Hospital for Special Surgery (HSS) has made dramatic progress in reducing opioid prescribing and implementing opioid-awareness tactics.

“We are implementing and perfecting initiatives that cover the full spectrum of opioid risk,” said Seth Waldman, MD, MBE, anesthesiologist and co-chair of the HSS Controlled Substances Task Force. “Our strategy encompasses the entire structure of the opioid life cycle. We are tackling this issue at every level to positively impact our community.”

HSS is a national leader in orthopedics, ranked No. 1 in the nation by U.S. News & World Report in its “Best Hospitals 2023-2024” survey.¹ HSS performed more than 28,000 surgical cases in 2022. Orthopedic surgery is associated with significant perioperative pain and has been identified as a risk for long-term opioid use and misuse, making it crucial for HSS to tackle this issue.2,3

In late 2017, HSS launched an interdisciplinary Controlled Substances Task Force to prevent and mediate potential problems with opioid medications. HSS has also taken strides to tackle pain management that spans the care continuum.

“Opioid stewardship has had a tremendous impact on prescribing culture at HSS,” said Bobby Stack, MS, assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the task force. “Large-scale initiatives have not only had direct effects on opioid safety at the hospital, including reduced prescribing, distribution of disposal packets, safety warnings, and patient education, but have also inspired departments and individuals to take initiative in pushing for smaller improvements.”

The Controlled Substances Task Force has achieved substantial results in curbing the opioid crisis in six key areas:

Further Reducing Opioid Prescribing
Since 2017, HSS has been implementing initiatives to reduce opioid prescribing across the hospital. These efforts have resulted in continued improvements to the efficacy of post-operative pain control, as seen by continuously improving patient satisfaction scores, as well as a reduction of roughly 1 million pills prescribed per year.

Expanding HSS Patient Education Content
HSS has continued to expand its patient education content with articles and videos covering a range of topics including safe opioid use and disposal, how to taper off opioids, and educating patients about what to expect regarding pain management after surgery. The task force is now branching out to more nuanced topics, including safe pain management for children and adolescents, safety tips for opioids and benzodiazepines, how to use naloxone, and more. Content is made available to patients through their MyHSS patient portal, as well as through QR codes in their discharge paperwork. This content is also on the HSS website and YouTube channel, with top-performing articles reaching nearly 10,000 views per month.

Offering CME Courses for Providers and Personalized Prescriber Training
Over the last six years, HSS has developed and implemented ongoing, personalized training to providers to help them prescribe appropriate amounts of opioid pills for their patients’ situations. Ongoing oversight by a multi-specialty committee tracks whether the training was effective based on provider compliance, and provides follow-up education as needed. HSS also offers numerous CME hours’ worth of educational content for new doctors, ongoing content for existing providers to meet New York State and federal prescribing requirements, as well as regular presentations and webinars focused on new developments and quality assurance in safe opioid prescribing. 

Providing Safe Opioid Disposal Methods to Patients and Staff
HSS was one of the first hospitals in the United States to distribute free prescription disposal products to patients at discharge. Since 2017, HSS has been sending every surgical patient home with DisposeRx®, a small packet of powder mixed with water and any leftover prescription pills to render them unusable. DisposeRx, Inc has also partnered with HSS on initiatives to hand out disposal products on site, as well as to mail every HSS employee a DisposeRx® packet as part of HSS’ annual Opioid Awareness Month initiatives. Our goal is to get as many safe disposal products into the community as we can. HSS also provides a safe drop-off location on campus for unused medications.

Distributing Naloxone and Providing Training for Overdose Emergencies
HSS is a proud participant in the New York State Opioid Overdose Prevention Program (OOPP). We provide free naloxone kits to high-risk surgical patients and make kits available to HSS staff upon request. This year, for Opioid Awareness Month in September, we are training staff in how to administer naloxone and focusing on an initiative to distribute naloxone kits to as many staff as we can. The more naloxone is available in the community, the more lives can potentially be saved.

Expanding Our Research

Starr Foundation Grant

In late 2019, HSS received a $3 million grant from the Starr Foundation to establish the C.V. Starr Endowed Chair in Pain Management. This grant has enhanced existing pain management studies and funded new studies, expediting the translation of research findings into practice, improving safe prescribing practices, and exploring alternatives to opioids.

Seth A. Waldman, MD, Co-Chairman of the HSS Controlled Substances Committee and Advisor of Opioid Prescribing Practices at HSS, is the inaugural holder of the chair. The grant funds a full-time PhD researcher dedicated to these topics, Alexandra Sideris, PhD

Pain Prevention Research Center (PPRC)

Founded in 2023, the Pain Prevention Research Center (PPRC) at HSS is unique in its focus and commitment to studying the prevention of pain and outcomes associated with pain. The PPRC’s goals include identifying innovative approaches to prevent pain; conducting high-quality research on the prevention of pain and its adverse effects; and expediting the development of therapies for those who suffer from pain.

Future Plans

Building on its well-rounded strategy for tackling the opioid epidemic, the HSS Opioid Task Force has future plans to both refine and expand its initiatives.

“We are working on evolving our methods to better identify patients at high risk for issues with controlled substances and pain management,” said Dr. Waldman. “We are developing new tools for preoperative screening to figure out which patients are at high risk for dependence or addiction, as well as which patients may need non-standardized pain management techniques or preventive strategies as part of their care. This information will help us to proactively provide more targeted and effective treatments and optimization throughout the patient’s clinical experience.”

“We are also working on developing media that will go beyond basic education about safe use, tapering, and disposal to delve into topics that we might not otherwise be discussing,” Ms. Stack said.

Moving forward, one of HSS’s major goals is to continue educating others about what we have learned about opioid management and education, so it becomes the standard of care at other hospitals and facilities. HSS also plans to keep learning from experts in the field to continue improving on a bio-psycho-social approach to pain management.

Seth Waldman, MD, MBE, is an anesthesiologist and co-chair of the HSS Controlled Substances Task Force. He is the Advisor for Opioid Prescribing Practices at HSS, the C.V. Starr Endowed Chair in Pain Management, a physician consultant to the U.S. Department of Justice and Drug Enforcement Administration, a consultant for the HSS Clinical Ethics Service, and a Pain Management Physician for the New York Giants.

Roberta (Bobby) Stack, MS, is an assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the HSS Controlled Substances Task Force.

References

1. https://health.usnews.com/media/best-hospitals/BH_Methodology_2023-2024
2. Soffin EM, Wu CL. Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review. HSS Journal. 2019 Feb; 15(1):57-65. doi: 10.1007/s11420-018-9652-2
3. Soffin EM, Waldman SA, Stack RJ, Liguori GA. An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017 Nov;125(5):1704-1713. doi: 10.1213/ANE.0000000000002433