Entering the Fourth Decade of the Opioid Crisis: An Institution's Efforts to Redefine Opioid Stewardship

The opioid crisis in the United States has grown increasingly complex as it enters its fourth decade. Synthetic opioids and psychostimulants now contribute to significant morbidity and mortality. Despite recent declining trends in overdose deaths, they remain magnitudes higher compared with the early years of the crisis. Against this backdrop, our institution formed an Opioid Stewardship Program in 2017 with representation from multiple disciplines and across 5 US states. Our mission was to establish and to maintain opioid analgesic prescribing and monitoring best practices through the development of guidelines, risk mitigation strategies, electronic health record tools, dashboards, and leadership push reports as well as education for patients and staff. As the epidemic evolved, we shifted our focus to opioid use disorder (OUD) screening and treatment, and community engagement. We continued to keep our institutional leadership abreast of regulatory and guideline updates-keeping them accountable for upholding best practices. Work to date has yielded improvements in opioid prescribing trends, enhanced awareness and knowledge of clinic staff across disciplines, and increasing numbers of patients with OUD receiving treatment. Much remains to be done, but we remain optimistic that our ongoing efforts will drive continued improvements-ultimately saving lives and improving access to OUD treatment.