Opioid stewardship is a comprehensive approach that promotes the judicious and appropriate prescribing of opioids, ensures proper disposal, prevents diversion, and addresses the health effects associated with opioid use. This includes identifying and treating opioid use disorder (OUD) and working to reduce mortality from opioid overdoses. Opioid stewardship programs are coordinated efforts designed to optimize the use of opioid medications, enhance patient outcomes, and minimize the risk of misuse and harm.
Elements in Developing an Opioid Stewardship Measurement Strategy
1. LEADERSHIP STRATEGY WITH PATIENT ENGAGEMENT
The Joint Commission’s Standards for Pain Assessment and Management include specific requirements related to leadership, medical staff engagement, and performance improvement. These standards emphasize the need for a designated leader or leadership team responsible for developing and overseeing performance improvement initiatives related to pain management. Additionally, they call for active involvement of the medical staff in shaping and monitoring opioid prescribing practices. An effective leadership team should raise awareness, establish a clear direction, and actively lead initiatives related to pain assessment and management.
2. ENVIRONMENTAL SCAN
Identifying and utilizing existing internal and external resources is essential to advancing your team’s vision for opioid stewardship. Building strong relationships—particularly with community partners—can enhance communication and ensure smoother transitions of care for patients. As emphasized by experts, “Effective solutions will only emerge from strong partnerships across government, legal, medical, and other community stakeholders.”
Hospitals and health systems should consider the following questions:
What services do we currently offer, and what is our capacity to expand or improve them?
Who are our key internal and external partners?
What relevant services, programs, or initiatives are already active within our community?
Understanding the existing resources for opioid use disorder (OUD) treatment within your hospital or health system is essential. Expanding access to care may involve increasing the number of providers who are waivered to prescribe medications for OUD. Empowering waivered clinicians to initiate treatment in emergency departments or inpatient settings has been shown to significantly improve the likelihood that patients will continue treatment—more so than providing referrals alone. However, identifying OUD and initiating treatment are only the beginning. Patient-centred success depends on effective care transitions and strong, collaborative partnerships.
3. MEASURE SELECTION
Measurement is a critical part of implementing and testing change.
Measures at the organizational level should fit the following criteria:
§ Address a problem in the hospital/health system or community.
§ Are supported with up-to-date and evidence-based internal guidelines, policies or procedures.
§ Show success or a need for improvement with established goals; are longitudinal.
§ Are supported with a level of evidence to positively influence patient outcomes.
§ Identify variation between departments, units or prescribers.
§ Are balanced with counter measures to ensure desired changes do not cause new problems in the system
4. GOAL SETTING AND IMPROVEMENT PLANNING
Setting clear, ambitious goals for selected measures is a powerful strategy to drive change and improvement. When creating a quality improvement plan—whether at the departmental or individual prescriber level—the emphasis should be on fostering a culture of safety. As the Institute for Healthcare Improvement notes, “Without a strong safety culture, the ability of an organization to authentically prioritize challenges and effectively implement protocols to improve the safety of pain management is likely to be limited.”
5. POLICIES AND CARE TEAM EDUCATION
As your team works to implement its opioid stewardship strategy and improvement plan, developing and regularly updating organizational guidelines, policies, and procedures should be a key priority. These documents should be evidence-based, comprehensive, cohesive, and compassionate, covering all aspects of opioid stewardship while remaining compliant with state and federal regulations. When reviewing policies, ensure they do not reinforce stigma and that they support individualized, patient-centred approaches to pain management. Including patients and caregiver advocates in the policy development process can offer meaningful insights, help address implicit biases, and promote more equitable, stigma-free care.
When considering education for prescribers and care teams, some essential points to address include:
§ The link between overprescribing and opioid dependency in individual patients
§ The link between overprescribing and diversion of opioids into the community
§ The mismatch between postoperative prescribing and patient actual use and need
§ Identifying medical conditions that put patients at high risk for dependency
§ The limited data that supports opioids for chronic pain
§ How to use opioid alternatives
While education and training alone may not always lead to changes in practice, there is broad agreement on the importance of ensuring that educational initiatives are comprehensive, far-reaching, and effectively implemented.
6. Patient Education and Engagement
It is critical to continuously revise and improve patient education material and tools to reflect changes in prescribing and treatment practices. To be successful, material and tools must align with the information that patients receive from providers.
Shared decision-making is a process that involves a partnership based on empathy that acknowledges patients know information about their body, circumstances and goals for life and health care. Shared decision-making is a conversation between the patient and the prescriber or care team member to discuss and mutually agree on a treatment plan.
Successful community education can help establish general expectations regarding appropriate pain management and opioid use. Educating the public, and the portion of the public who are patients, should be done simultaneously with other initiatives.
Addressing the opioid epidemic will not be a swift or simple task. However, through the consistent application of the evidence-based strategies outlined here, we can reduce the rise in opioid use, lower opioid overdose deaths, and increase the identification and treatment of opioid use disorder.
- Dr Jeeva George, Assistant Professor
A revolutionary new blood biomarker, brain-derived tau (BD-tau), is outperforming current diagnostic methods used to detect Alzheimer’s-related neurodegeneration. BD-tau shows remarkable specificity to Alzheimer's disease and correlates closely with AD biomarkers found in cerebrospinal fluid. This promising advancement could greatly enhance the accuracy and accessibility of Alzheimer's diagnosis.
BD-Tau: A Game-Changer in Alzheimer's Diagnostics
Current blood diagnostic methods, including amyloid beta and phosphorylated tau (p-tau) tests, show good accuracy and alignment with corresponding CSF and neuroimaging biomarkers within the amyloid/tau/neurodegeneration (A/T/(N)) framework. However, a major challenge remains: detecting brain-specific markers of neurodegeneration in the blood, without interference from proteins produced by other parts of the body. BD-tau, however, is distinctively more specific to Alzheimer’s disease, offering a solution to this challenge.
Understanding Tau and Its Role in Alzheimer's Disease
Tau is a microtubule-associated protein essential for maintaining the stability of microtubules in the brain’s neurons. In Alzheimer's, tau becomes abnormally hyperphosphorylated, causing microtubules to disassemble. The resulting tau molecules aggregate into paired helical filaments, forming neurofibrillary tangles that disrupt neuronal function. A growing body of evidence suggests that tau hyperphosphorylation results from disruptions in cellular signalling, particularly an imbalance in protein kinases and phosphatases. One of the key triggers of this imbalance appears to be ß-amyloid peptides, which are known to play a pivotal role in the onset of Alzheimer’s disease.
Addressing the Accessibility Issue
Currently, diagnosing Alzheimer’s typically requires expensive neuroimaging tests, such as MRI and PET scans. These tests not only have long wait times but are also inaccessible to many patients, creating a major barrier to early diagnosis and treatment. The development of a blood test for BD-tau represents a significant step toward improving accessibility and affordability in Alzheimer's diagnostics. The primary goal of blood-based biomarkers is to improve the quality of life for patients by enhancing clinical confidence, risk prediction, and early diagnosis.
BD-Tau: A More Specific Alzheimer’s Biomarker
Unlike neurofilament light (NfL), a protein marker of nerve cell damage that rises in Alzheimer's, Parkinson's, and other dementias, BD-tau offers increased specificity to Alzheimer's disease. NfL, while useful for detecting nerve cell damage, is not effective for distinguishing Alzheimer's from other neurodegenerative conditions. To selectively detect BD-tau and avoid interference from non-brain tau, a new technique has been developed, incorporating a specially designed antibody that binds exclusively to brain-derived tau. This innovation allows for highly accurate detection of BD-tau in blood samples.
Correlation with Disease Progression
Tests utilizing BD-tau have shown that blood levels of this biomarker correlate with tau levels in the CSF, and importantly, they reliably distinguish Alzheimer’s from other neurodegenerative diseases. Furthermore, BD-tau levels align with the severity of amyloid plaques and tau tangles found in brain tissue, as confirmed by brain autopsy analyses. This correlation offers a new way to monitor the severity and progression of Alzheimer's disease.
BD-Tau as a Therapeutic Target
BD-tau is not only valuable for diagnosing Alzheimer’s but also for evaluating potential therapeutic strategies targeting tau in neurodegenerative diseases. These include:
Inhibiting abnormal tau hyperphosphorylation through modulation of specific protein kinases (e.g., GSK-3ß, CDK5).
Disassembling tau aggregates with compounds like Methylene blue and Antharaquinones.
Stabilizing microtubules using compounds such as Taxol and its derivatives.
Triggering tau clearance pathways through the ubiquitin-proteasome system or autophagy.
Tau immunotherapy.
Anti-inflammatory treatments.
These strategies offer hope for developing treatments that may slow or even reverse the effects of tau-related neurodegeneration.
Reference:
2.The Role of Tau in Alzheimer's Disease and Related Disorders - PMC
4.Phosphorylated Tau in Alzheimer’s Disease and Other Tauopathies - PMC
- Dr Jeeva George, Assistant Professor