Academic Detailing in Opioid Stewardship

Visually engaging materials, flashy business attire, easy access to information, and free lunch all in the comfort of your own office—who wouldn’t be sold?

These are just a few of the highly effective tactics of pharmaceutical detailing, a marketing technique used in the pharmaceutical industry to sell medications to clinicians. In 2016, pharmaceutical companies spent $5.6 billion on prescriber detailing. Since pharmaceutical detailers’ primary goal is often to maximize sales, this tactic can lead to deceptive communication and distort clinicians’ views and prescribing practices.

In response, Dr. Jerry Avorn, co-director of the National Resource Center for Academic Detailing (NaRCAD), coined “academic detailing”—an educational outreach intervention focused on supporting effective medical decisions by providing clinicians with easy access to the most current and accurate evidence. Since founding NaRCAD in 2010 with Dr. Michael Fischer, Dr. Avorn and the NaRCAD team have become global leaders in clinical outreach education and have significantly broadened academic detailing’s application in the medical field. Today, academic detailing programs have been adopted by multiple countries including Australia, Canada, the United Kingdom, Japan, and Brazil.

Similar to pharmaceutical detailing, academic detailing consists of interactive, one-on-one, office-based visits. But, in academic detailing, sales representatives are substituted for healthcare professionals and marketing techniques for practical and unbiased information. Academic detailers educate clinicians on targeted clinical topics and develop behavior change goals to improve patient care. Through follow-up visits, academic detailers provide ongoing support to help clinicians meet these goals.

Pharmaceutical marketing has been particularly harmful to opioid prescribing practices in the United States. Opioid pharmaceutical companies have been successful at influencing clinician prescribing behavior through targeted marketing campaigns and payments for patient prescriptions. Between 2013 and 2015, pharmaceutical companies spent $39.7 million in nonresearch-based opioid marketing targeted at over 65,000 physicians. These techniques have not only been associated with a significant increase in the number of opioid prescriptions but also in opioid-related mortality.

Between harmful marketing campaigns, changes to opioid prescribing guidelines, legal ramifications, and the many other competing demands of clinicians, effective and safe opioid management can often be emotionally-taxing and feel unattainable. The Center for Innovation in Academic Detailing on Opioids (CIAO) addresses these very challenges. By applying the innovation of academic detailing to opioid and chronic pain management, CIAO supports clinicians and patients in navigating one of the most complex public health crises faced by the United States healthcare system.

CIAO initially began as a project funded by the California Healthcare Foundation to provide academic detailing to increase naloxone prescribing among clinicians in San Francisco, California. Naloxone is a life-saving overdose reversal medication and can reduce overdose mortality when co-prescribed with opioid medications; however, at the time, patients on opioid therapy often did not receive naloxone. After receiving CIAO’s academic detailing intervention, clinicians’ naloxone prescriptions increased 11-fold compared to those who did not receive the training.

The success of this pilot program spurred the expansion of CIAO. With support from the Center for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH), CIAO now provides academic detailing training and technical assistance on opioid stewardship throughout California and other U.S. states. Through trainings on topics such as urine drug screening, management of opioid use disorder, and alternative chronic pain therapies, CIAO helps promote balanced approaches to opioid management. Since 2016, CIAO has worked with public health officials and medical clinicians from 17 counties in California, hosted over 50 webinars and talks, and provided 8,000 copies of educational materials to clinic networks and health plan systems across the United States.

With the volume of opioid use management publications increasing exponentially and the opioid epidemic killing over 46,000 Americans per year, the need for innovative and effective solutions in clinical care is more essential than ever. Academic detailing efforts have valuable potential to improve the landscape of opioid management, save lives, and prevent physician burnout.

CIAO is based out of the San Francisco Department of Public Health’s Center on Substance Use and Health in collaboration with the California Department of Public Health and the CDC. Learn more about CIAO’s services and materials here.

Post by Nicola Gerbino, Program Assistant, Center for Innovation in Academic Detailing on Opioid Stewardship