A group of doctors and administrators has come up with an ambitious plan for Colorado hospitals to reduce the amount of opioids they prescribe while still treating pain effectively, according to an article in the Denver Post. The plan will roll out this year as a six-month pilot program at eight hospitals and three freestanding emergency rooms.
Health officials hope to analyze data from the program at the three-month mark to determine what’s working best and what’s not, said Diane Rossi MacKay of the Colorado Hospital Association (CHA).
The effort is part of a broad rethinking in the medical world about the place opioids, blamed for an epidemic of addiction and overdoses, should hold in medicine, according to the Post article.
“For far too long, pain has equaled an opioid,” said Dr. Don Stader, an emergency room physician at Swedish Medical Center in Denver. “And that’s what got us into this problem.”
The Centers for Disease Control and Prevention (CDC) and state regulators across the country have issued guidelines calling on doctors to reduce their opioid prescribing. In addition, the FDA recently announced that it is seeking to remove one opioid, Opana ER (extended-release oxymorphone, Endo Pharmaceuticals), from the market because its addictive potential outweighs its medical benefit.
The new program that Stader helped put together—along with the CHA and members of the Colorado chapter of the American College of Emergency Physicians—aims to go even further by combining a number of ideas. Not only does the program encourage doctors to prescribe fewer opioids, it also provides them with condition-specific guidelines for treatments that can be used to control pain effectively without narcotics. In some cases, the guidelines might call for substituting doses of Tylenol and other medications for opioids, Stader said. In others, there are “trigger point” procedures that could work.
The plan won’t eliminate opioids in the hospital altogether, Stader said, but they aren’t the first resort in most instances.
In addition, the program calls for hospitals and emergency rooms to become front-line players in providing treatment to people with opioid addiction. Instead of telling patients to find a rehabilitation clinic first, doctors potentially could start patients on medication-assisted therapy with a drug such as buprenorphine or methadone right away. In a state survey conducted this year, people who successfully quit heroin identified such treatment as the most effective way to do so.
At the Swedish Medical Center, Stader said the hospital began implementing some elements of the program a year ago. In that time, the hospital has cut its opioid use by 30%, he said.
“Opioids now aren’t just the only drugs we use,” he said. “They’re part of a large collection of drugs that we use to control pain better.”
Source: The Denver Post; June 12, 2017.