10 Emergency Departments Reduce Opioid Prescriptions by 36%
For around two decades years now, many health care providers have witnessed first-hand the results of the so-called “opioid epidemic.” Operating under the early mistaken idea that prescription opioids were not highly addictive for most patients, health care providers regularly turned to a long list of prescription painkillers when needed. Meds like Oxycodone, Percocet, Vicodin, Hydrocodone, or Fentanyl became the second line of defense when patients were not responding to treatment from ibuprofen or acetaminophen.
However, as the rate of opioid prescription built momentum, the demand and use soon began barreling out of control. Over the last 10 years, prescriptions for four opioids (hydrocodone, oxycodone, methadone, and morphine) surged by 270 percent according to the Center for Investigative Reporting. In 2016 alone, retail pharmacies dispensed more than 214 million opioid prescriptions – more than 66 prescriptions for every 100 people, and more prescriptions than any other country in the world.
Because these opioids also offered the added sense of euphoria, misuse and addiction became especially common, and addicted patients began “shopping” between doctors who would prescribe them. When they could no longer obtain their prescription drugs, some patients turned to heroine or cheap, imported versions of Fentanyl, leading not only lead to a staggering increase in addictions and death, but a rise in staph cases which are becoming increasingly common for injection drug users.
Overall nationwide drug death statistics for show that more than 64,000 people died from drug overdoses in 2016 – including a 540% increase in Fentanyl deaths in the last three years. In 2015 and 2016, nearly 117,000 Americans died from opioid overdoses – more than the number of U.S. soldiers killed in the Korean, Vietnam, Iraq, and Afghanistan wars combined. These statistics have lead to numerous cities and states, as well as the U.S. Justice Department, to sue opioid manufacturers and distributors. Recently, President Trump declared U.S. opioid use a “public health crisis” and called for immediate responsive action from prescription drug creators, physicians, and insurance companies.
In response, a group of 10 hospitals in Colorado decided to take action and participate in a six-month pilot project called the Colorado Opioid Safety Collaborative, aimed at cutting the use of prescription painkillers. Sponsored by the Colorado Hospital Association (CHA), the project is believed to be the first in the nation to include this many hospitals, and set a goal of a 15 percent reduction in the participating emergency departments.
Amazingly, the pilot instead yielded an average 36 percent reduction of opioid prescriptions, or 35,000 fewer doses than were prescribed during the same period in 2016. The program also resulted in a 31.4 percent increase in the administration of alternatives to opioids (ALTOs), such as less addictive alternative medicines, like ketamine and lidocaine (during the project, lidocaine usage increased by 451 percent and Ketamine increased 144 percent). The participants also promoted patient education, showing ways to help manage pain with over the counter painkillers, ice and heat, stretches, and other techniques.
With such great success, the CHA began looking for ways to share best practices and lessons learned through the pilot program, and formed the Colorado ALTO Project. The project’s online presence includes details and results from the pilot program, training materials, patient pathway documents, and ACEP guidelines. The group hopes to see these techniques implemented not only in all Colorado EDs but in other hospital systems across the nation. The project also conducts live trainings, and offers a free detailed implementation plan for other hospital systems.
By collaborating with other emergency departments and working together to share successes and lessons learned, health care providers on the front lines are taking effective and powerful steps to combat the opioid epidemic. By shifting perspectives for both providers and patients, and sharing useful tools and alternatives, the statistics on addiction, abuse, and deaths will hopefully begin steadily decreasing in the years to come.