Carolinas Opioid Reduction Effort

The goal of the Carolinas Opioid Reduction Effort (CORE) Project strategy is to find alternatives to opioids and disseminate findings to patients, providers, and healthcare systems in the Carolinas and beyond. The project focuses on reducing avoidable opioid prescribing and consumption in elective orthopedic surgery.

The CORE Project is a clinical trial involving hundreds of patients from multiple orthopedic subspecialty clinics within OrthoCarolina — Foot & Ankle, Hand, Hip & Knee, Spine, and Sports Medicine.

Combating a crisis

The CORE project is the nation’s first comprehensive study designed to assess the effectiveness of opioid-free pain management for patients undergoing orthopedic surgery.

CORE Expansion

This 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.

Starting in March 2018, OrthoCarolina Research Institute expanded 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.

Next Steps for CORE

  1. Begin population health projects, implement opioid-free and opioid-minimizing pathways into large healthcare networks, track opioid related complications, patient satisfaction, and cost.
  2. 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
75 The United States accounts for 5% of the global population, but 75% of the global prescription opiate consumption.
1 NC is home to the #1 worst city in the US for opioid abuse (Wilmington). Three other cities in NC are also in the Top 20 (Hickory, Jacksonville, and Fayetteville).
50 The percentage of patients taking opioids for at least 3 months are still on opioids 5 years later.

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. Learn more about the opioid crisis in North Carolina HERE.


“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.”