To help combat the opioid epidemic, Dr. Scott Gottlieb, commissioner of the U.S. Food and Drug Administration, and U.S. Sen. Michael Bennet on Tuesday visited the Emergency Room at UCHealth’s University of Colorado Hospital to learn about opioid prescribing guidelines and see a one-click innovation that helps doctors instantly see patients’ history of pain medication prescriptions.
Emergency departments throughout the UCHealth system are among the first providers in the nation who can access the one-click tool.
“We’re on the front lines of the opioid epidemic,” Dr. Richard Zane, UCHealth’s Executive Director of Emergency Services and Chair of the Department of Emergency Medicine at the Colorado School of Medicine, told Gottlieb and Bennet. “It’s really a scourge.”
Zane said he used to study weapons of mass destruction and that opioids are a perfect weapon because they’re so addictive, accessible and destructive.
Throughout UCHealth, doctors are using new guidelines to prescribe opioid pain medications less often. When they do think opioids are warranted, they’re also prescribing fewer pills. At the same time, UCHealth is one of the only academic medical systems in the country now doing random drug testing on doctors and staff members to ensure that staff members are avoiding opioids and providing the safest care for patients.
At University of Colorado Hospital, the percentage of patients leaving the ER with a prescription for pain medication has dropped from 20 percent about three years ago to about 12 percent now.
“Can that number go lower?” asked Sen. Bennet. “What’s the answer for exposing fewer people?”
Zane pointed to the one-click innovation as a tool that could drive opioid prescriptions even lower.
Dr. Jason Hoppe, an Emergency Medicine physician, worked with state managers of the Colorado Prescription Drug Monitoring Program to help design the new system. Colorado, like most states, has had a drug monitoring program for several years, but it hasn’t been easy to use.
“Previously, it took three to five minutes and seven to 35 clicks to get in,” Dr. Hoppe said of the drug monitoring program.
Now the prescription records are tied in with patient records. With a single click, ER docs can see exactly how many prescriptions a patient has filled at various locations throughout the state.
People struggling with addiction sometimes “doctor shop” to access as many pills as possible.
The new system allows providers to immediately determine if they are caring for a high-risk patient. An earlier study at University of Colorado Hospital found that among patients who had not been taking opioid medications, 17 percent who received hospital prescriptions were still on opioids a year later. Therefore, preventing unnecessary prescriptions can help decrease future use and improve patient safety.
Hoppe and state officials received a federal grant and will be tracking what happens with the new system. They’re already finding that ER docs are clicking much more often on the prescription database. They also will be following up to see if patients are using opioids after ER visits.
Hoppe and Zane both said that making decisions about opioid prescriptions is one of the greatest challenges for ER providers.
Hoppe said he cares for patients who tell him that if they can’t get prescription opioids, they’ll switch to heroin instead. Rather than responding with a prescription for opioid medications, Hoppe said he tries to offer those patients access to treatment for addiction or help with alternative treatments for pain. Throughout the UCHealth System, providers are using a variety of alternatives including physical therapy, rehabilitation, massage treatments and non-opioid relief.
“These are always hard conversations,” Hoppe said.