Tackling Opioids as a Region: Q&A with Physician Chair of the Northeast Ohio Hospital Opioid Consortium

In November, Cleveland Clinic psychiatrist David Streem, MD, took the helm as physician chair of the Northeast Ohio Hospital Opioid Consortium after being appointed to the post by the group’s executive committee. Founded in 2016, the consortium encourages collaboration among hospital systems in Northeast Ohio to address the region’s opioid epidemic. Participating hospitals include Cleveland Clinic, MetroHealth System (the public health system for the county that includes Cleveland), the Northeast Ohio VA Healthcare System, St. Vincent’s Charity Medical Center and University Hospitals. The consortium is an integrated program of The Center for Health Affairs, a regional hospital association representing the collective voice of Northeast Ohio hospitals.

In a Consult QD article from last spring, Dr. Streem — who serves as Section Head of the Alcohol and Drug Recovery Center in Cleveland Clinic’s Department of Psychiatry and Psychology — shared how the Northeast Ohio Hospital Opioid Consortium works, what Cleveland Clinic contributes and what healthcare providers can do to curb the opioid crisis. Soon after beginning his two-year term as the consortium’s physician chair, Dr. Streem discussed his vision and plans for the group.

Q: Are there similar regional organizations around the nation to address the opioid epidemic?

Dr. Streem: I’ve heard of others, but national public health officials have told us the Northeast Ohio consortium seems to be the best organized and most inclusive. Other regional efforts often have some hospital systems that participate, while others decide not to. Every healthcare organization that decides not to participate negatively affects the ability of the remaining members to impact the community as a whole.

Q: That inclusiveness is certainly a point of distinction for the Northeast Ohio consortium. Are there others?

Dr. Streem: I really like the fact that the consortium allows hospital members to tackle the opiate community problem using their individual strengths. For example, MetroHealth has a particular interest in naloxone distribution and training of addiction specialists, while Cleveland Clinic has interest in issues like surgical prescribing, pain management of patients in the ED and treatment of patients with particular heart infections related to intravenous opiate use. Everybody contributes their expertise, then we share our experiences with the other members of the consortium.

Q: What advancements has the consortium made recently?

Dr. Streem: We just created a comprehensive education program for nurses and unlicensed caregivers who interact with patients and families, which was developed in-house with the collaboration of nurses and other educators in all our member hospitals. We finalized the online nursing program and are in the process of rolling it out to member hospitals for onboarding. That’s something that one single hospital would have found challenging to do alone.

Q: What is your vision for the opioid consortium as its new chair?

Dr. Streem: We have to move from an organization that has come up with ideas and shared best practices regarding opiate misuse to an organization that actively delivers on some of those ideas, like the educational program for nurses and other caregivers. We also need to better address how we manage both acute postoperative pain and chronic pain issues as a community, as well as how we develop and collect data among the organizations in the consortium to measure impact and improve outcomes.

Q: Within that broader mission, are there specific goals for the next two years you can share?

Dr. Streem: One of our major goals is increasing access and use of nasal naloxone. We’re also very interested in increasing use of medication-assisted treatment for opiate use disorder by 100% by the fourth quarter of 2020. In addition, we want all consortium hospitals to offer high-risk substance use disorder patients an addiction consultation service for evaluation and follow-up by the end of my term.

Q: What advice do you have for regions that want to explore forming a similar consortium?

Dr. Streem: Having a separate organization like The Center for Health Affairs that houses the collaborative effort, rather than it being hosted by one of the member hospitals, is a key to our consortium’s success. When one organization has too much ownership, it negatively impacts the collaboration. The second thing is the people that I work with in the consortium have different work badges, but we don’t see each other as competitors. When we walk into these meetings and work collectively on projects, we see ourselves as colleagues.