To curb opioid misuse, a group of Colorado hospitals and EDs are launching a six-month pilot program that relies on a uniquely comprehensive approach designed to "dramatically" cut the amount of opioids they prescribe, John Ingold writes for the Denver Post.
'More of a leap than a step'
The program, which involves eight hospitals in the state and three freestanding EDs, was designed by Don Stader, a doctor in the ED at Swedish Medical Center, in collaboration with the Colorado Hospital Association and members of the state chapter of the American College of Emergency Physicians.
The program goes beyond simply asking doctors to limit the number of opioids they prescribe by combining various recommendations on the topic to provide prescribers with a set of comprehensive guidelines outlining how to treat pain caused by specific conditions without the use of narcotics, Ingold writes. For example, the guidelines might recommend that instead of prescribing opioids, a physician use Tylenol, another opioid-alternative, or "trigger point" procedures designed to reduce pain.
The guidelines also urge hospitals and EDs "to become front-line players in providing treatment to people with opioid addiction," Ingold writes. For instance, the guidelines notes that physicians could immediately start a patient who misuses drugs on treatments such as buprenorphine or methadone, rather than referring such patients to a rehab clinic first.
Robert Valuck, the director of the Colorado Consortium for Prescription Drug Abuse Prevention and one of the people who helped develop the program, said, "I don't know of anywhere that has guidelines this comprehensive. ... It's more of a leap than a step, and that is new."
Ultimately, while the program doesn't aim to eliminate the use of opioids in the hospital, it does remove opioids as a go-to response when treating pain for many cases, Ingold writes. "We need to really think about and revolutionize how we control pain," Stader said. "For far too long, pain has equaled an opioid. ... And that's what got us into this problem."
Another potential benefit, according to Valuck is cutting the overall amount of unused opioids. Valuck explained that most people who begin to misuse opioids do so by taking unused pills that were prescribed to someone else, such as a bottle of leftover pills stashed in a medicine cabinet. In fact, according to Valuck, cutting the overall amount of unused opioids is "the biggest piece of low-hanging fruit in this whole thing."
Swedish began implementing the pilot program's guidelines about a year ago and, since then Stader said opioid prescribing at the hospital is down 30 percent.
Yampa Valley Medical Center, another pilot program participant, also has reported early positive results.
YVMC officials say the hospital typically treats an overdose patient or someone who has presented with withdrawal symptoms on a weekly basis. Since implementing the guidelines, the physicians at the hospital are reporting that treating patients' pain with alternative methods and medications is just as effective as using opioids, according to Wes Hunter, the director of pharmacy for the hospital and the president of the Colorado State Board of Pharmacy. "We don't want to be the place that fails on pain," said Hunter (Ingold, Denver Post, 6/12).
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Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties, and providers typically intervene only after the patient has shown signs of misuse and addiction.
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