Content warning: This story contains mention of addiction, drug use and overdose. Recovery from addiction is possible. For help, please call the confidential referral hotline, 1-800-622-HELP, or view options on campus through University Health Services.

Opioid prescription is common practice following extreme pain resulting from surgeries and other invasive procedures. While effective, opiates are highly addictive painkillers that are typically prescribed in low doses. In an effort to mitigate the burden of disease, medical professionals are searching for alternatives to opiate drugs.

A team of doctors and medical professionals at the University of Wisconsin School of Medicine and Public Health recently published a study highlighting how a de-implementation strategy in opiate prescription is linked to a reduction in opioid overdose.

Andrew Quanbeck and Dr. Randall Brown are the principal investigators of this study, providing insight as to what a de-implementation strategy is and why it has proven effective.

“There’s been a lot of concern around opioid overdose in relation to the prescription of opioids through the early 2010s, and then the 2022 CDC expert guidelines came out,” Brown said. “These guidelines described possible strategies to reduce opiate dosage and championed for improved clinical monitoring strategies to ensure that opiate prescription was being handled appropriately.”

Brown and Quanbeck tested how clinicians can integrate the CDC’s guidelines into their own practice.

The study consisted of 8,978 patients across 56 clinics to determine if tightly following the CDC’s guidelines while also implementing a de-implementation would reduce the likelihood of addiction.

“We saw a 6% reduction in average morphine equivalent dose, and dosage is the biggest risk predictor for overdose,” Quanbeck said.

This number may be small, but this is major progress from where science was on opioid usage a decade ago, according to Quanbeck.

A de-implementation strategy entails physicians avoiding prescribing patients opiate painkillers.

The type of alternative strategy used depends on a clinic’s specific set of guidelines, base performance levels and the cost efficiency of alternative methods.

In medical practice there are other alternatives to opioids, including ibuprofen and acetaminophen. Quanbeck and Brown’s findings suggest researchers should look deeper into ways to manage chronic pain without medication as well.

According to Brown, to fully understand the opioid epidemic, it is important to understand that illicit forms of opiates, such as fentanyl, account for many of the overdose fatalities. UW students should refrain from getting pills that were not prescribed by a doctor as many of these pills are counterfeits and are extremely dangerous.

The Wisconsin Department of Health Services found that synthetic opioids were present in 91% of opioid overdose deaths, accounting for 73% of all overdose fatalities.

DHS’s key findings included fentanyl and similar synthetic opioids are one of the primary drivers of opioid overdose.

Fentanyl is extremely hard to detect, and consuming even a small amount is enough to kill someone, making it incredibly dangerous.

“We’ve been disseminating results through research venues and through health system conferences,” Brown said.

Opioid use has been happening for decades and there’s no such thing as a “one-size-fits-all” solution. Implementing a strategy holistically poses challenges, thus more research is needed to maximize the efficacy of a solution.

“We cannot solve the whole problem with any one study,” Quanbeck said. “I think we are making progress, but it is going to take several more decades before it’s fully remedied. We are going to keep working at this.”

The opioid crisis has revealed that the medical world struggles with treating chronic pain, according to Quanbeck. The system is not prepared to treat chronic pain, which is the next study Quanbeck is planning.

“We are going to be looking at doing implementation research to scale up and test integrative medicine approaches for chronic pain management in place of opioids,” Quanbeck said.

For example, UW Health has an integrated medicine program, which offers interventions like physical therapy, cognitive behavioral therapy, yoga and acupuncture.

One barrier to action for the team is that the majority of Wisconsin is made up of rural communities.

“Roughly 70% of our geography is rural,” Brown said. “In urban centers, there is better access to a better standard of care, consultants and other experts. Whereas in rural areas, that is more of a challenge getting patients access to that standard of care.”

Naloxone, which is a drug that reverses the effects of an overdose, is not readily available in rural communities as they lack the infrastructure to house naloxone in community buildings. Only 19 states allow EMTs to administer naloxone as efforts are being made to institute naloxone in schools.

The 2023 School Access to Naloxone Act recommends that opioid overdose management plans be incorporated into the school’s response plans.

As for UW students, students should be aware of what naloxone is and how to use it properly. Students should be aware of dangerous counterfeit or laced opioids.

University Health Services offers an interactive map indicating where naloxone boxes are on campus.

The university added 13 more sites in 2023 to address ongoing opioid usage and encourages students to take advantage of this service to protect themselves and their peers.

Recovery resources:

Hotlines:

• National Overdose Prevention Lifeline: 1-800-484-3731

• Safe Communities 24/7 Recovery Hotline: 608-228-1278

• University Health Services 24-hour crisis intervention: 608-265-5600

• Wisconsin Addiction Recovery Hotline: 211

Additional recovery resources:

• Badger Recovery, a program for students in or considering recovery from substance use: recovery@uhs.wisc.edu

• Behavioral Health Resource Center of Dane County for treatment and recovery resources: 608-267-2244

• Connections Counseling: 608-233-2100, connectionscounseling.com

• End Overdose online Opioid Overdose Response Training: endoverdose.net/professional-training

• Other campus recovery resources: alcoholanddruginfo.students.wisc.edu/resources

• Safe Communities: 608-441-3060, safercommunity.net

• Tellurian Behavioral Health: 608-222-7311, tellurian.org

• Truth Initiative: truthinitiative.org