Hospital ERs Cut Opioid Prescribing But Still Reduce Pain : Shots - Health News Collaboration was key for the 10 emergency rooms that cut opioid prescriptions by 36 percent. Doctors say they now use less addictive medicines to manage pain and have shifted patients' expectations.
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These 10 ERs Sharply Reduced Opioid Use And Still Eased Pain

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These 10 ERs Sharply Reduced Opioid Use And Still Eased Pain

These 10 ERs Sharply Reduced Opioid Use And Still Eased Pain

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SCOTT SIMON, HOST:

A group of hospitals in Colorado set out to reduce opioid use and achieved some dramatic results. The experiment took place in emergency rooms. From Colorado Public Radio, John Daley explains.

JOHN DALEY, BYLINE: Ashley Copeland endured a headache for a week and a half before coming into the emergency department at Swedish Medical Center near Denver.

ASHLEY COPELAND: This morning, I woke up, and it felt 10 times worse.

DALEY: Her care team determined an irritated nerve, a condition called occipital neuralgia, was causing the pain. Typically, a patient like Copeland would first get an anti-inflammatory, an analgesic like Motrin or a pain medicine like Tylenol. Her ER physician, Dr. Peter Bakes, says the second line of treatment would be...

PETER BAKES: Stronger pain medicines - things like Percocet or Vicodin - medications that certainly have contributed to the rising opioid epidemic.

DALEY: But at Swedish, that's changed. Dr. Bakes treated Copeland with the Motrin and then a nerve blocker. Copeland was soon discharged and advised to use over-the-counter meds for pain.

COPELAND: It was a lot better just because I'm used to going to the doctor if I had a headache and them being like, OK. Let's put you on, like, some really strong painkillers.

BAKES: We were able to effectively treat her without any narcotic pain medicines, and she actually did much better.

DALEY: Swedish was one of 10 Colorado Hospitals, large and small, urban and rural, to take part in a six-month project. They set out to reduce opioid use by 15 percent. But Dr. Don Stader says new research shows the hospitals did much better - a 36 percent drop on average.

DON STADER: We all see the carnage that this opioid epidemic has brought - how dangerous it's been for our patients and how damaging it's been for our communities. And we know that we have to do something radically different.

DALEY: The hospitals coordinated providers, pharmacies, clinical staff and administrators. They changed their protocols and started deploying lidocaine patches for pain or using targeted injections guided by ultrasound, like the one Stader demonstrates in the emergency department.

STADER: It allows us to look into the body to...

DALEY: Stader says they switched from opioid pain medications to alternatives considered safer and less problematic - drugs like ketamine and lidocaine, other medications used as anesthesia.

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DALEY: There was some pushback from patients, says Claire Duncan, one of Swedish's head ER nurses.

CLAIRE DUNCAN: They say only narcotics work for me because they haven't had the experience of that multifaceted care. They don't expect that ibuprofen's going to work or that ibuprofen plus Tylenol plus a heating pad plus stretching measures - they don't expect that to work.

DALEY: And it's been a big deal for the hospital to move away from opioids, too, says Duncan.

DUNCAN: It's definitely a big culture change, encouraging our staff to have those conversations with patients and change the conversation from I'm giving you medications for pain to we're going to do all of these things to help treat your pain, to help you cope with your pain, to help you understand your pain.

DALEY: The new guidelines have allowed health care professionals to help combat the opioid crisis, which they unwittingly helped to create, says ER doctor Peter Bakes.

BAKES: Any thinking physician or provider of patient care really felt, to some extent, guilty, but at least powerless to enact meaningful change.

DALEY: Dr. Lewis Nelson is the chair of emergency medicine at Rutgers New Jersey Medical School in Newark. He says the effort is noteworthy since it focuses on emergency departments in many hospitals - not just one.

LEWIS NELSON: It gives us that breadth of approach. It's something that you don't usually see. I think the results of the study are obviously wonderful.

DALEY: Nelson thinks opioids still have their place in the ER, but in many cases, much safer alternatives are the better way to go. For NPR News, I'm John Daley in Denver.

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SIMON: And that story is part of a reporting partnership between NPR, Colorado Public Radio and Kaiser Health News.

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SIMON: This is NPR News.

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