Wednesday, January 15, 2025
1/15/2025
Project Abstract The Ohio State University Wexner Medical Center (OSUWMC) Project AVOID [AlternatiVe to opiOIDs in the emergency department (ED)] will implement, evaluate, and quality assure a screening, intervention, and referral to treatment program for both pain and opioid use disorder (OUD). Our multi-modal approach will reduce opioid exposure amongst patients who are in pain, at-risk for opioid use disorder, or already suffering from opioid use disorder. Opioid overdose deaths remain disproportionally high in Ohio, especially among racial/ethnic minorities, as does morbidity from substance use (e.g., infectious disease, motor vehicle accidents). Yet, efforts to reduce opioid prescriptions contribute to the epidemic of undertreated pain. There is an urgent and imperative need to reduce opioid use for patients at risk of opioid use disorder (OUD) and provide evidence-based alternatives to opioids for pain management in the emergency department (ED). A key advantage of our two large volume EDs and their broad catchment area is the capacity to access diverse and underserved populations. We routinely encounter non-English speaking immigrants, pregnant women, human trafficking victims, racial and gender minorities, and both rural Appalachian and urban populations suffering from extreme poverty. Project AVOID will respond to this need by expanding alternatives to opioids for pain management and reducing the likelihood of future opioid misuse. Our innovative approach adapts the SBIRT framework in an integrated fashion for both pain and disordered opioid use. We will do this by: (i) multi-modal, person-centered approaches to changing practice among existing ED staff and (ii) co-locating parallel support staff from our HealthNow program (i.e. screening, consult service, and post-ED patient assessment/support). Specifically, we will address health disparities related to pain and opioid use disorders by: (i) developing and implementing a system to identify ED patients with moderate to severe pain or history of non-medical opioid use, (ii) expanding non-opioid pain treatments, pain education, and non-medical coping adjuncts for pain, and (iii) improving discharge instructions and referral for pain and OUD. In addition, we will leverage the ED Project AVOID components to engage and reinforce ED provider knowledge of pain responses/help-seeking behaviors across different cultures as well as develop, implement, and quality assure protocols and training procedures for alternatives to opioids and OUD interventions within the ED. Measurable objectives for Project AVOID include assessment of each project goal (e.g., number of patients: (i) screened for pain/OUD, (ii) receiving ED intervention for pain/OUD, and (iii) receiving discharge planning and appropriate referral. Success of our project will be enhanced through a multidisciplinary group of experts (led by Dr. Michael S. Lyons) with previous shared experience on past clinical and research projects surrounding screening and intervention for OUD. Project AVOID will significantly impact the ability to screen and provide evidence-based, culturally competent pain management and OUD intervention for approximately 5,475 (Y1), 7,500 (Y2), 8,000 (Y3) patients, totaling 20,975 ED patients across the proposed 3-year intervention in the Greater Columbus, Ohio region.
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