News of the opioid crisis has inundated the headlines in recent years. Despite the attention this problem has received, America experienced a record number of overdose deaths last year.  While we are nowhere near the end of this public health tragedy, I believe the first rays of sunshine are peeking over the horizon.

Opioid lawsuit settlements now total over $50 billion. This extraordinary sum of money will be distributed over approximately 20 years to states, municipalities and others with the express purpose of supporting opioid addiction prevention, treatment and recovery.

Substantial funding from the opioid settlements should be directed to the tens of millions of Americans already harmed by inappropriate opioid use by ensuring appropriate treatment, rehabilitation and public education to eliminate the stigma of addiction. Prevention strategies should be a priority for any funds expended.

With that in mind, I was heartened to see, in the state of Iowa, results from an opioid prevention program at a recent press conference with Attorney General Brenna Bird. Surgery is a key gateway to persistent opioid use. The Billion Pill Pledge, operated by Goldfinch Health, is an innovative three-pronged approach to opioid first dose prevention surrounding surgery, including:

1. Education and implementation support to providers for delivery of care according to opioid-minimizing Enhanced Recovery After Surgery (ERAS) protocols.
2. Disciplined prescribing of opioids after surgery.
3. Appropriate disposal of leftover opioids after surgery.

The mission of the Billion Pill Pledge is to eliminate one billion leftover opioid pills from our homes and communities — pills dispensed after surgery that could otherwise lead to misuse or diversion. I believe this program can serve as a nationwide model by making critical opioid settlement investment decisions in real time. Here’s why:

ERAS protocols have proven to improve surgical outcomes and decrease post-surgical complications. These protocols include numerous interventions to ensure patients are medically optimized for surgery, allow patients to drink a clear beverage two to four hours prior to surgery. Another critical element of these protocols —  multimodal pain management — has demonstrated the ability to help patients achieve better pain management with fewer opioids. Minimizing narcotics decreases the risk of addiction, nausea, constipation and withdrawal.

ERAS protocols not only reduce reliance on opioids but they have also been proven to reduce costs and decrease surgical complications and hospital length of stay. At a time when our health care system is under greater stress than ever, these additional benefits and savings are critically important.

Rural communities are frequently overlooked and underfunded. The Billion Pill Pledge supports hospitals across the state, including rural communities. As a physician who provides care in these communities, we appreciate this attention and assistance.

As a surgeon, I see many patients over age 65 and many other patients who are enrolled in Medicaid. Both populations are at-risk. For instance, more than 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2021. Last year, Stanford University researchers found that among Medicaid patients who had never taken an opioid, 30% developed an opioid dependency following their first prescription.

Clinically validated, opioid-minimizing ERAS protocols — the foundation for the Billion Pill Pledge — have demonstrated an ability to reduce health disparities.

If this is so great, why aren’t all surgeons doing this already? To put it simply, change is difficult in health care. Research has shown it takes 17 years for evidence-based practices to be adopted as standard.

I can tell you there is still much work to do with opioid prescribing and pain management around surgery. Consider in the early 2000s, the leading brand-name opioid manufacturer spent over $100 million annually marketing opioids to physicians. Why did they do this year after year? Because it worked. With two decades of misinformation and misguided prescribing to correct, we cannot solve this through regulations alone. And it most certainly is not going to happen without engaging prescribers, providing education and support where it’s needed.

A major struggle in the American health care system is our disproportionate expenditure on treatment of disease rather than its prevention. I believe the opioid crisis will be best managed by appropriate reduction of narcotic exposure and subsequent prevention of addiction by minimizing the number of narcotics prescribed while simultaneously improving the patients’ pain control, outcomes and experience.

So much has gone wrong in the creation of the opioid crisis over the last 20 years. Now we have a chance to get it right by following the lead of our neighbors next door in Iowa and bringing the Billion Pill Pledge program to Nebraska.

This story was originally published by Nebraska Examiner, an editorially independent newsroom providing a hard-hitting, daily flow of news. It is part of the national nonprofit States Newsroom. Find more at nebraskaexaminer.com.