Ten Colorado ERs switch away from opioids, and the results are encouraging

Ten Colorado ERs switch away from opioids, and the results are encouraging

“We all see the carnage that this opioid epidemic has brought. We all see how dangerous it’s been for patients, and how damaging it’s been for our communities. And we know that we have to do something radically different.”

So says Dr. Don Stader, an ER physician at Swedish Medical Center's emergency department in Englewood, Colo.

The idea of replacing the usual opioids – Vicodin, Percoset and the rest – with non-addictive painkillers, has been a huge success in Colorado and is catching on at hospital ERs around the country.

As we reported in 2016, the emergency department at St. Joseph’s Regional Medical Center in Paterson, N.J., one of the busiest ERs in the nation, has cut its use of opioids in half.

Now, a group of emergency departments at 10 Colorado hospitals has completed a pilot project designed to cut opioid use, and found it wildly successful.

Termed the Colorado Opioid Safety Collaborative, the program was launched by the Colorado Hospital Association and billed as the first of its kind in the nation to include this number of hospitals in the effort.

The goal was for the group of hospitals to reduce opioids by 15 percent, reported Kaiser Health News (KHN). Instead, Stader said the hospitals did much better: down 36 percent on average.

“It’s really a revolution in how we approach patients and approach pain, and I think it’s a revolution in pain management that’s going to help us end the opioid epidemic,” Stader says.

The decrease amounted to 35,000 fewer opioid doses than during the same period in 2016, KHN said.

A well-organized plan

This is a lot more than just encouraging ER docs to go a little easier on opioids.

Called the Colorado ALTO Project – ALTO for “alternatives to opioids” – the program is coordinated across providers, pharmacies, clinical staff and administrators. KHN says it introduces new procedures…like using non-opioid patches for pain.

Doctors are switching from the usual oxycodone, hydrocodone or fentanyl to “safer and less addictive alternatives, like ketamine and lidocaine, an anesthetic commonly used by dentists,” Stader explained.

Lidocaine led the field of alternative painkillers, increasing in the ERs 451 percent. Ketamine use was up 144 percent.

Meanwhile common opioids were used much less: methadone (down 51 percent), oxycodone (down 43 percent), hydrocodone (down 39 percent), codeine (down 35 percent) and fentanyl (down 11 percent), KHN reported.

Claire Duncan, a clinical nurse coordinator in the Swedish emergency department, told KHN that the new program required “intensive training. And there was some pushback, more from patients than from medical staff.”

“They say ‘only narcotics work for me, only narcotics work for me.’ Because they haven’t had the experience of that multifaceted care, they don’t expect that ibuprofen is going to work or that ibuprofen plus Tylenol, plus a heating pad, plus stretching measures, they don’t expect that to work,” Duncan said.

Duncan added that the program required “a big culture change, encouraging staff to change the conversation from pain medication alone to ways to treat your pain to help you cope with your pain to help you understand your pain.”

Dr. Peter Bakes of the Swedish ER said the staff are all too familiar with the effects of the opioid epidemic. He said the project has “changed minds and allowed health care professionals to help combat the opioid crisis they unwittingly helped to create.”

“I think that any thinking person or any thinking physician, or provider of patient care, really felt to some extent guilty, but … powerless to enact meaningful change,” Bakes said.

Here at Novus, we are 100% behind all efforts to reduce exposure to opioids unless its unavoidable and encourage other ERs to follow suit. Meanwhile if you or someone you care for needs help because of substance use, don’t hesitate to call us.

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