Geisinger-Lewistown Hospital responds to local opioid crisis

LEWISTOWN — Geisinger-Lewistown Hospital has implemented a variety of initiatives to combat opioid and benzodiazepine addiction in the local community.

“While we want to effectively manage our patients’ chronic pain, we are putting measures in place to ensure our staff is trained to both prevent new cases of addiction and treat existing cases,” said Kirk Thomas, GLH Chief Administrative Officer.

Cybele Pacheco, GLH department director of community medicine, agreed with Thomas.

“Opioids and benzodiazepines have a place in medicine for a variety of treatments, (but) zero pain is not realistic,” Pacheco said.

In one year, the GLH clinical pharmacist has seen a 26 percent reduction in the number of patients on opioids and a 37 percent reduction of patients using a combination of opioids and benzodiazepines. Much of this has been accomplished by the pharmacist spending dedicated time with patients, working with providers, following pill counts, med-use agreements and guidelines established by the Prescription Drug Monitoring Program, as well as devising a treatment de-escalation plan and “end points to get off meds,” Pacheco said.

“We have reduced the total daily dose of opioids in the western region–Lewistown, State College and areas nearby–by 42 percent,” Thomas said. “Since 2014, Geisinger has reduced controlled substance prescribing in ambulatory settings, including emergency departments and community practice locations, from 60,000 to 28,000 per month. We are committed to keep bringing the numbers down.”

There has also been 1500 in-person clinical visits documented in one year. At a typical visit, a clinician will do an extensive intake, review imaging and pathology, conduct pain and depression surveys and opioid risk assessments, and have the patient sign a medication use agreement, which stipulates the specific pharmacy and provider the patient will use, acknowledges the probability of random drug screenings and pill counts, promises that medications will only be used as directed and includes the de-escalation plan devised. The result of this agreement has contributed to a 13 percent reduction in ER visits.

In addition to the clinical efforts, the Medication Take Back Program has collected more than 116 pounds of expired medications locally, since 2017. Take back boxes are located at the CareSite pharmacy in the hospital and in Belleville.

On a broader scale, Geisinger Health Plan has implemented a campaign to provide community awareness and education through the “We’ve #HadEnough, have you?” campaign. Public forums have brought together a panel to discuss topics that directly affect communities, including how opioids affect the brain and where addicts can find help. Though no local panel has been scheduled yet, videos of other #HadEnough panels can be viewed on YouTube.

While patient support is crucial, GLH case management, social workers and Community Health Assistants are available to support both opioid patients and their families. CHA goes to the patients’ homes to assess living conditions, the overall environment and safety concerns.

“They give a birds-

eye, hands-on view,” Pacheco said.

There are also support groups available in the community, such as Narcotics Anonymous, Spirit of Freedom Ministries Children Intervention Program and HERT–Helping to Educate and Recover with Time.

In the spring, GLH is planning a Community Day to showcase these and other efforts, and possibly have their own #HadEnough panel. In the meantime, Thomas and Pacheco want to encourage patients to educate themselves about the addictive dangers in opioids and opioid/benzodiazepine combinations right at the beginning of their pain management program.

“The presence of an opioid, illicit or prescribed by a doctor, was identified in 85 percent of drug-related overdose deaths in Pennsylvania in 2016,” Thomas said.

GLH efforts to combat opioid addiction have caught the attention of medical professionals nationally and are the just start of things locally.

“It’s ever evolving,” said Thomas. “People around the country are trying to learn from Geisinger (and we are) committed to building the communities we serve. This is very important to us.”