Opioid Use Disorder (OUD) often arises from legally prescribed medications, such as pain medications initiated during an inpatient hospital stay, which can then escalate if factors such as pain management and opioid prescribing are not thoughtful. Managing opioid use in the acute care setting requires a multifaceted Opioid Stewardship Program (OSP). The push for a hospital opioid stewardship program is driven by ensuring safe care through preventing adverse drug events and improving the safe and effective use while also adequately controlling pain. The Joint Commission targeted these concerns in their release of the Pain Assessment and Management Standards, categorized into four chapters:
- Leadership (LD)
- Medical Staff (MS)
- Provisions of Care, Treatment, and Services (PC)
- Performance Improvement (PI)
Drug overdoses drive the need for hospital opioid stewardship programs
Drug overdose deaths have skyrocketed during the COVID-19 pandemic, in part due to healthcare accessibility and resources being especially limited. According to CDC data released in 2025, there was an overall decrease in overdose deaths nationwide, but the levels have not fallen back to pre-pandemic levels. Work remains to improve hospital opioid stewardship programs.
It is now more imperative than ever to build a robust OSP. Nevertheless, executing a plan to implement a program at your facility is easier said than done. According to a study published by Ardeljan et al. only 23% of United States acute care hospitals have adopted an Opioid Stewardship Program.
Goals of OSPs
Best practices surrounding opioid stewardship vary and depend on many factors in a hospital, such as size, acuity level, specialties, geographic location, etc. However, the most common shared goals include:
- Reduce opioid overuse, misuse, and abuse
- Prevent addiction and sequelae (overdose)
- Improve pain management outcomes while reducing risks (e.g., adverse drug event (ADE))
- Increase awareness and treatment of OUD
- Create partnerships between the patient, providers, and the community
- Improve the patient experience
Four barriers to implementing a hospital opioid stewardship program
With these best practices in mind, there are four main barriers to implementing an Opioid Stewardship Program at a hospital or health system.
1. Poor leadership commitment and resource allocation
The foundational groundwork for a strong OSP involves senior leadership willing to devote financial and physical resources. Without this cornerstone, the OSP can fragment from the start.
2. Lack of best practice models or easily transferrable programs
Trying to standardize and implement an OSP enterprise-wide is one of the biggest challenges faced by pharmacy leadership. It is essential to ensure an organizational or system-level approach. Optimizing the usage of a data-driven tool could alleviate this strain by reducing the burden of physical work on pharmacy staff.
3. Lack of physician availability or involvement
Interprofessional engagement is essential in the early stages of OSP development, as establishing trust between departments can further strengthen the initiative and lead to widespread adoption.
4. Challenges around the data necessary to support robust program development
This is by far the most complicated barrier to overcome due to factors such as volume or how the data is structured. Not only must the OSP ensure data integrity within its initiatives, but the OSP leadership team must also know how to use and interpret the data to track progress and improve outcomes.
Normalizing opioid use data – the power of Sentri7® Pharmacy’s MME calculation
A data-driven Opioid Stewardship Program utilizing tools such as Sentri7 Pharmacy can promote best practices and overcome several barriers, such as those listed above. Sentri7 provides AI-powered tools that are crucial to reducing opioid use and improving patient safety through evidence-based rules and analytics. During a pilot study involving an Integrated Delivery Network (IDN), novel opportunities in measuring and monitoring opioid use were identified. MME is a strategy to normalize doses of opioids with variable potencies, which improves transparency into opioid use. The higher the MME, the greater the risk for a serious ADE.
Normalizing opioid use data is valuable, but it is also tremendously difficult in the acute care setting due to many factors, such as opioid naming and variation, potency differences, multiple routes of use, poor documentation, combination products, and exclusion of certain uses. Sentri7 Pharmacy's Opioid Stewardship was validated during the pilot study with the IDN. Anticipating the expected MME allowed the pharmacy team in the pilot program to understand opioid use patterns, evaluate inappropriate use, launch improvement efforts, and support continuous improvement in their clinical initiatives.
The pilot study also identified opportunities to increase the IDN’s use of multi-modal therapies for pain management, which can prevent over-sedation events and reduce the risk of other side effects associated with opioids. Moreover, the pilot study revealed the value of real-time interventions on MME > 90 per day, identification of opioids co-administered with benzodiazepines, and lack of bowel regimen for patients receiving opioids. This versatile approach to rule-based, inpatient-focused opioid stewardship provides real-time surveillance coupled with evidence-based, clear opportunities for intervention.
Tackling opioid stewardship with teams and technology
As the opioid crisis continues in the United States, it is imperative that hospitals support pharmacy teams in these efforts. By identifying goals for a hospital Opioid Stewardship Program, recognizing and overcoming barriers to entry, implementing best practices, and leveraging tools to support a data-driven program, hospitals can start to see success in operationalizing pain management strategies.
Learn how pharmacy teams can take a leadership role in opioid stewardship programs in our free guide.