Pushing alternatives, not opioids

UCHealth’s northern Colorado ERs participate in pilot program that hopes to tackle opioid addiction and abuse
June 12th, 2017

pharmacist measures out a prescription

UCHealth’s northern Colorado emergency departments are among those leading an effort to reformulate pain management protocols to address the nation’s opioid addiction epidemic.

On June 5, eight hospitals and three freestanding emergency departments in Colorado launched an opioid pilot program created by the Colorado Hospital Association. UCHealth’s Medical Center of the Rockies in Loveland; Poudre Valley Hospital and UCHealth Emergency Room on Harmony Road, both in Fort Collins; Greeley Emergency and Surgery Center; and soon-to-be UCHealth partner, Yampa Valley Medical Center in Steamboat Springs, are participating in the pilot.

The initiative is one of the largest opioid research efforts in the United States, according to the CHA. The program involves implementation of new opioid prescribing and treatment guidelines set by the Colorado Chapter of the American College of Emergency Physicians. The goal: reduce the administration of opioids by ER clinicians to address the overall misuse of pain medications.

“This is something that the government has said they’ll start requiring of everyone in about two years,” said Dr. Jamie Teumer, an emergency physician at UCHealth and medical director of MCR’s emergency department in Loveland. “We wanted to get that head start as we believe we owe it to our population to be doing this.”

Misuse and abuse

Statistics about opioid misuse reveal a harsh reality. Colorado has the 12th highest rate of misuse and abuse of prescription opioids across all 50 states, according to CHA. In 2015, PVH’s emergency room reported 17 heroin and opioid overdoses and, in 2016, that number almost doubled, to 31. Two-thirds of overdoses are from opioids, while the other third is from heroin, often an alternative for an addict who can’t get opioids, Teumer said. Four of every 10 adults will admit to the misuse of some sort of medication, mainly painkillers, he added.

Before the pilot, UCHealth had already identified that too many people were coming to their ERs with the purpose of getting opioids and efforts were underway to change protocols and guidelines, including duration of prescriptions and for which ailments.

“We were already working on about 60 percent of what’s in the guidelines, so when they (CHA) called it was easy to say, ‘yes,’ and transition into this pilot,” Teumer said. “We can only control so much, but we are in a position to reduce the risk for a population who is at a high risk for (opioid) abuse.”

While not part of the pilot, UCHealth University of Colorado Hospital in Aurora, and UCHealth Memorial Hospital in Colorado Springs have  initiated new pain management protocols in the emergency departments, Teumer said.

At Memorial, physicians have been working toward reducing opioid prescriptions for the past two years by making changes in how opioids are prescribed in the emergency departments at both Memorial Hospital Central and Memorial Hospital North.

“We think this is a community problem and the ER is a part of fixing and helping our community,” said Dr. George Hertner, chief of emergency medicine for UCHealth Memorial Hospital.

“We’re trying to make a conscious effort to apply up-to-date and reasonable pain control approaches, including the appropriate use of narcotic therapy vs. alternative therapies.  We have seen dramatic changes in our prescribing habits.   By comparison, in 2016 vs. the previous year, we’ve had a 248 percent reduction in narcotic prescriptions out of the emergency departments.”

Because of those changes, Memorial has reduced the number of opioids that have been prescribed by the equivalent of a metric ton — 2,200 pounds, Hertner said. UCHealth Memorial is working on a research paper about its work.

Alternatives to opioids

Under the pilot, treatment guidelines recommend the use of alternatives to opioids (ALTOs) as a first-line treatment for pain rather than opioids. For example, Lidocaine, which is non-habit forming, has traditionally been used as a numbing agent. But research supports that it also works well for kidney stones, a condition resulting in pain so severe that it was thought only opioids could tackle it.

Haldol is another example. Historically used for sedation, medical professionals are now finding it can help with certain types of pain conditions that involve excessive vomiting. It can also be used for severe headaches, Teumer said. Nitrous oxide also is an alternative. Although its medical use has been around for years, it only recently became part of UCHealth’s pain management portfolio in birthing units, and also will be used in ERs starting in September.photo of pills from a pill bottle

“There are legitimate reasons to have pain medications, and we don’t deny that fact and those people pain medications,” Teumer said. “But if we have an opportunity to provide an alternative, then we will.”

The pilot program is necessary to gather data, establish information about best practices and to determine the efficiency of using ALTOs for managing acute pain, according to the CHA. CHA and its partners, the Colorado Chapter of the American College of Emergency Physicians, the Colorado Consortium for Prescription Drug Abuse Prevention, Telligen and the Colorado Emergency Nurses Association, formed the Colorado Opioid Safety Collaborative and will oversee this program.