Behavioral Health, Equity, and Opioid Prescribing: Looking Back at 2018

Our average life expectancy in America has declined again, as it has done for the past few years. The Centers for Disease Control and Prevention recently released data showing that this trend is largely driven by increases in deaths by suicide and drug overdose. These two areas have been key parts of our work over the last year – continuing our focus on addressing our State’s behavioral health needs and opioid prescribing and use. I also see addressing health equity, helping to build the structures that allow everyone to have a fair opportunity to be healthier, as a huge driver of longer lives across the country. These three areas have the most potential to reverse our national trend.

In the past we have focused on behavioral health broadly, looking at how to best integrate behavioral health into primary care, and this year had the opportunity to look specifically at Suicide Care. I think we are strongest when our topic areas are complementary and are able to build off one another from year to year. Suicide is both a preventable outcome and a public health issue. The effect of a suicide on family members, friends, and clinical providers is long-lasting and profound. Our goal is integration of implementable standards for suicide care, assessment, management, treatment, and supporting suicide loss survivors into clinical care pathways. Our recommendations are applicable to in- and out-patient care settings including for care transitions, behavioral health providers and clinics, and for specialty types of care like cancer care. The National Suicide Prevention Lifeline is available by phone at 1-800-273-8255.

This year were also able to focus specially on the health care for those who are lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ). We acknowledge that LGBTQ people share common challenges and have distinct health care needs from those who do not identify as LGBTQ. We based recommendations in a whole-person care framework, taking into consideration a person’s multiple individual factors that make up health, wellness, and experience like behavioral health and past trauma. We organize the recommendations around communication, language, and inclusive environments; screening and taking a social and sexual history, and areas requiring LGBTQ-specific standards and systems of care.

Our recommendations around post-operative opioid prescribing build off our 2015 AMDG Interagency Guideline on Prescribing Opioids for Pain and the best practices of the 2017 AMDG/Bree Dental Guideline on Prescribing Opioids for Acute Pain Management. Although opioids are often indicated to manage severe acute postoperative pain, studies show that patients often receive more opioids for home use than are necessary for pain related to many procedures. This may result in dangerous and illegal diversion of opioids to those for whom opioids were not prescribed. While there is no optimal number of pills for a given procedure, our recommendations are intended to serve as a general framework for managing postoperative pain, while minimizing leftover pills.

I encourage you to read all three of these reports and to think about what adopting these in your health system, health plan, or everyday life would look like.

Don’t forget to comment on our Lumbar Fusion Bundled Payment Model and Warranty and the Collaborative Care for Chronic Pain Report and Recommendations. You can also read our 2018 report to the Washington State Legislature here.

Ginny Weir, MPH
Director, Bree Collaborative