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| TO: | Area Directors Area Chief Medical Officers Clinical Directors |
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| FROM: | Director, Indian Health Service |
| SUBJECT: | Opioid Stewardship Management Plans |
The purpose of this Special General Memorandum (SGM) is to promote the safe and effective use of opioids in all Indian Health Service (IHS) direct service health care facilities through the creation and maintenance of mandatory Opioid Stewardship Management Plans.
BACKGROUND
Opioid stewardship is a health systems journey that involves every level of the organization. Each Opioid Stewardship Management plan promotes necessary steps for improved processes and patient outcomes. A plan includes evidence-based prescribing practice guidelines, facility-level policies, person-centered practices to promote safe prescribing and use of opioids for managing pain, and non-opioid pain management strategies. These plans optimize treatment effectiveness by maximizing clinical benefits and minimizing adverse consequences, which include overdose, misuse, and diversion. Opioid stewardship activities are optimized when emphasis is placed on patient and/or provider communication, and when patients and care teams are involved in comprehensive treatment planning. Additionally, leadership commitment and support are vital and necessary for implementation of these plans.
MANDATORY OPIOID STEWARDSHIP PLANS
It is the policy of the IHS that all direct service health care facilities provide oversight and support of opioid prescribing activities through a local, Opioid Stewardship Management Plan that includes relevant scope, objectives, staff responsibilities, and time frames that support ongoing oversight and evaluation. Each plan may be developed by the facility pain management team, with oversight by the facility Clinical Director, and may be developed to cover multiple facilities in the same region through coordination with the Service Unit or Area Office. The initial implementation timeline is no later than (6) months following the release of this SGM.
- Each Opioid Stewardship Management Plan should also align with the requirements outlined in Part 3, Chapter 30, “Chronic Non-Cancer Pain Management,” Indian Health Manual (IHM) and Part 3, Chapter 32, “State Prescription Drug Monitoring Program," IHM.
- Each local Opioid Stewardship Management plan will include the following: relevant scope, organizational, and facility goals related to opioid prescribing and accreditation requirements; identification of measurable key performance indicators; and relevant evaluation strategies.
- Opioid-related metrics are reported from the Opioid Surveillance Dashboard and other relevant data sources necessary to support key performance indicators and improvement activities. These metrics should be reviewed by relevant leadership as described in the Agency Opioid Stewardship Management Plan.
- Each Opioid Stewardship Management plan should be updated at least every 2 years.
- Ensures that all Federal IHS employees and clinical residents are required to successfully complete IHS-approved annual training on overdose reversal and naloxone administration.
I am relying on the full support of Area Directors, Area Chief Medical Officers, and Clinical Directors to ensure the safety of American Indian and Alaska Native beneficiaries through the implementation and maintenance of mandatory Opioid Stewardship Management plans.
Effective Date: This SGM becomes effective on the date signed.
/Roselyn Tso/
Roselyn Tso
Director
Indian Health Service
