Core - Carolinas Opiod Reduction Effort
The CORE Project
The CORE Project strategy is the development, implementation, and validation of evidence-based strategies to reduce avoidable opioid prescribing and consumption in elective orthopedic surgery in the Carolinas and beyond. In other words, the goal of the CORE Project is to find alternatives to opioids and disseminate findings to patients, providers, and healthcare systems.
The CORE Project is a multi-subspecialty clinical trial that will involve a number of orthopedic subspecialty clinics within OrthoCarolina -- Foot & Ankle, Hand, Hip & Knee, Spine, and Sports Medicine.
This larger initiative has developed out of a study that was conducted by Dr. Nady Hamid for patients needing a total shoulder arthroplasty. Patients in that study gave consent to be placed into a group receiving a non-opioid, multi-modal pathway. Results from that smaller study showed that treating patients without opioids was a safe and effective way to manage post-operative pain following total shoulder arthroplasty.
OrthoCarolina Research Institute has now been given the opportunity to expand the trial across different types of orthopedic surgeries and to include more patients. Patients who give consent to participate in the multi-subspecialty clinical trial will either be randomly (like flipping a coin) placed into a group receiving their surgeon’s standard pain medication protocol or into a group receiving a non-opioid, multi-modal pathway. This study is being funded through a multi-year research grant awarded by the Duke Endowment.
Physicians leading the CORE Project team are:
- Dr. Nady Hamid, Principal Investigator and Upper Extremity Sports Champion
- Dr. Walter Beaver, Hip & Knee Champion
- Dr. Matt Chapman, Spine Champion
- Dr. James Fleischli, Lower Extremity Sports Champion
- Dr. Todd Irwin, Foot & Ankle Champion
- Dr. Bryan Loeffler, Hand Champion
About the Study
- OrthoCarolina physicians and the OrthoCarolina Research Institute (OCRI) are creating and implementing the Carolinas Opioid Reduction Effort (CORE) project, the nation’s first comprehensive study designed to assess the effectiveness of opioid-free pain management for patients undergoing orthopedic surgery.
- The study, launching March 2018, will include hundreds of patients from common surgeries across various orthopedic subspecialities. This groundbreaking research project seeks to identify safe, effective opioid-free alternative pain management options, eventually offering the national medical community a new protocol for future patient care.
Next Steps for CORE
- Begin population health projects, implement opioid-free and opioid-minimizing pathways into large healthcare networks, track opioid related complications, patient satisfaction, and cost.
- Outreach campaign to patients, providers, hospitals, and payeors to: increase awareness, provide alternative medicine pain management strategies, and demonstrate cost and safety.
Current Practice for Most Surgical Care
- Opioids are a staple of pain management, given at the time of block for discomfort
- During surgery, opioids are given in response to fluctuations in heart rate
- In post-operative recovery room, they are given in anticipation of pain
- On the surgical floor, they are given whenever patient rates pain at or above 6/10
- Opioids are routinely given at time of discharge
- Complications due to opioid consumption are considered routine surgical recovery
About Opioid Abuse
- Opioid abuse statistics are staggering. More people die in the state of North Carolina of an accidental drug overdose, typically opioid-related, than any other cause of accidental death.
- In the United States, more patients are dying from substance abuse every year than from car accidents.
- Little has been done to date within the medical community to specifically answer how to prevent future opioid abuse at the initial encounter.
- North Carolina Attorney General Josh Stein has been vocal in his fight to combat the growing opioid epidemic in the state and is a supporter of the CORE Research Study. “Opioid painkillers are highly addictive; the CDC reports that one of five patients who take 10 days of opioids will still be taking them 12 months later. And they are often not the most effective way to treat pain, as OrthoCarolina's preliminary findings suggest. I’m encouraged by OrthoCarolina's work to find non-addictive ways to treat pain, and I look forward to hearing about the results of its larger study.” – N.C. Attorney General Josh Stein
The United States accounts for 5% of the global population, but 75% of the global prescription opiate consumption.
North Carolina is home to the #1 worst city in the United States for opioid abuse (Wilmington). Three other cities in North Carolina are also in the Top 20 (Hickory, Jacksonville, and Fayetteville).
50% of patients taking opioids for at least 3 months are still on opioids 5 years later.