Tapering opioid prescriptions and reducing polypharmacy for inpatients with spinal cord injury at Rancho Los Amigos National Rehabilitation Center

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Article discusses the hospital-wide changes implemented to eliminate opioid overuse and reduce polypharmacy in spinal cord injury (SCI) inpatients at Rancho Los Amigos National Rehabilitation Center (RLANRC). An interdisciplinary ad hoc committee of clinicians was assembled to ensure the safety of patients, educate patients and providers to the danger of opioid use, and provide optimal medical and nonmedical pain relief interventions. The project entailed literature research, direct intervention with physicians, a communications campaign, and training. Intervention goals were reached with a 56-percent decrease in the percentage of SCI inpatients on more than 30 mg/d of oral-morphine analgesic-equivalents and a 35-percent decrease in the percentage of polypharmacy (>10 routine medications) for all RLANRC SCI inpatients. The measured outcomes and anecdotal observations illustrate the effectiveness of opioid tapering in a rehabilitation hospital using educational methods alone, without coercion of prescribers or patients.

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