The opioid crisis affects communities across North Carolina. Many cases of opioid misuse begin with a prescription, often after surgery. That makes surgical care an important place to focus prevention efforts.
By reducing opioid prescriptions and offering effective alternatives to manage pain during and after orthopedic surgery, we can limit the number of opioids that enter homes and communities. This does not solve the entire problem, but it addresses a leading cause of how opioids get into the home in the first place.
OCRI’s CORE (Carolinas Opioid Reduction Effort) Project was built on the idea that small changes in how we approach pain management can lead to meaningful differences over time.
My name is Sandra Marshall, and I serve as the Research Application and Education Coordinator at the OrthoCarolina Research Institute (OCRI). My new role at OCRI helps connect research to everyday care. I work with clinicians, researchers, and partners to bring studies and findings into practical use for patients and across healthcare systems.
Everyday I have the opportunity introduce new approaches into clinical workflows, track how they perform and making adjustments along the way. I focus on education and outreach efforts, creating materials and opportunities that help both providers and patients better understand and apply our research. Put simply, my work makes research accessible and relevant so it can support better care for patients across the state of North Carolina and beyond.
Right now, much of my work is centered on an OCRI initiative called The CORE Project.
The CORE Project, which stands for the Carolinas Opioid Reduction Effort, was developed by Dr. Nady Hamid and OCRI to help address the opioid crisis in the United States. It began with a simple but important question in 2015, could surgery be done without opioids while still managing pain effectively?
That question led to the development of a non-opioid surgical pathway that addresses pain before, during, and after surgery.
With support from The Duke Endowment, OCRI conducted a randomized clinical trial in 2017 comparing traditional opioid-based care with non-opioid alternatives. The results showed that patients in the non-opioid group reported lower pain levels and experienced fewer side effects.
From there, the work continued to grow. OCRI published its findings and developed tools to help bring these approaches into everyday healthcare.
The CORE Project is about preventing opioid misuse before a prescription is even written. Treatment for addiction is vital for the health of our communities, but our focus is on reducing the need for opioids in the first place, especially related to opioid prescription before, during, and after surgery. By lowering the number of opioids prescribed, we can help reduce the risk of misuse, dependence, and long-term harm.
The CORE Project has moved beyond testing ideas and into implementing what we’ve learned. We are actively educating patients about their pain management options and encouraging open conversations with their healthcare providers. At the same time, we continue to improve our educational materials and adjust based on what we are learning.
Through the EPIC MyChart system (the most widely used electronic medical record system in the US), patients can opt in to learn more about opioid-reducing options before surgery. When they do, they gain access to information that helps them understand their choices and ask informed questions. Their decision is also visible to their care team, creating an opportunity for conversation about pain management options.
The CORE Project was designed to be patient-centered. Instead of asking providers to change how they work, we built tools that fit into existing systems. The workflow starts with the patient, gives them access to information, and supports a conversation with their provider at the right time. This system requires healthcare providers to be open to new approaches, patients that are willing to ask questions, and organizations that are committed to improving care.
While we continue this work within our own system, we are also focused on expanding it. We are in the final phase of our current grant, which centers on outreach across North Carolina, particularly in both urban and rural communities most affected by opioid misuse.
The next phase of The CORE Project is focused on connection and expansion. That includes:
Awareness is an important part of this work. Sharing information, starting conversations, and asking questions all make a difference.
If you are an OrthoCarolina patient, consider opting in to the one question survey in your MyChart that asks if you want to explore opioid-minimizing treatment. We also encourage you to have a conversation with your care team about your options before a procedure.
You can also CLICK THIS LINK to explore the resource OCRI developed specifically for patients who are interested in exploring their opioid minimizing surgical options.
If you are a healthcare provider, talk with your patients and explore how opioid-reducing strategies could fit into your practice.
If you are part of a healthcare organization, there may be opportunities to collaborate and bring these approaches into your system.
You can learn more at opioidreduction.com or support OCRI at orthocarolinaresearch.org.
Working on The CORE Project is a reminder of why research matters. It is not just about discovering something new. It is about what happens when we take those findings and apply them in a way that improves care for patients in the Carolinas and beyond.
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