A six-month pilot program among several Colorado hospitals and health care facilities to reduce opioid prescriptions by 15% has been a success, with every participating facility cutting opioid prescriptions by at least 30%—and some by nearly 50%, according to a study released last week.

Background

The program, which involves eight hospitals in the state and two freestanding EDs, was designed by Don Stader, an emergency medicine physician at Swedish Medical Center, in collaboration with the Colorado Hospital Association and members of the state chapter of the American College of Emergency Physicians.

The initiative went beyond simply asking doctors to limit the number of opioids they prescribe by providing prescribers with a set of comprehensive guidelines outlining how to treat pain caused by specific conditions without the use of narcotics. For example, depending on the source and level of pain, the guidelines might have recommended that instead of prescribing opioids, a physician use Tylenol, another opioid-alternative, or "trigger point" procedures designed to reduce pain.

The guidelines also involved providing patients prescribed opioids with pamphlets that outline why the facilities were focusing on providing alternative options for pain relief, as well as information about possible opioid misuse and resources for help.

The guidelines also asked hospitals to be on the front lines in providing treatment for opioid misuse. For instance, the guidelines noted that physicians could immediately start a patient who misuses drugs on treatments such as buprenorphine or methadone, rather than referring such patients to a rehab clinic first.

Ultimately, while the program didn't aim to eliminate the use of opioids in the hospital, it did try to remove opioids as a go-to response when treating pain for many cases. In 2017, two of the program participants—Swedish Medical Center and Yampa Valley Medical Center—reported early positive results, with Swedish cutting opioid prescribing by 30%.

Results of the initiative

The study, which was presented Thursday at a Colorado Hospital Association forum on opioid use, found that the pilot program reduced opioid prescriptions by 36% among participating facilities in 2017, when compared to the same period in 2016. Two UCHealth facilities reported a more than 40% decline in opioid prescriptions, according to the study.

According to a news release, the total reduction amounts to around 35,000 fewer opioids being administered. And when the researchers assessed opioid prescriptions by six specific conditions, the pilot program cut opioid prescribing across all of them, although not by equal amounts. While the participating facilities switched from prescribing mostly opioids to mostly alternatives for kidney stones and back pain, they still prescribed opioids more than 75% of the time for broken bones and cancer-related pain. 

Overall, Eric Olsen, an emergency physician at Medical Center of the Rockies, said of the initiative, "It's fantastic. It shows this is a very good and viable way to successfully treat people for painful conditions."

Olsen added that this reduction in opioids was only the first step, and work is being done to make developments in outpatient settings. "Expect more things to come," he said.

However, Heidi Wald, a professor at the University of Colorado School of Medicine cautioned that the results had some caveats. First, the initiative did not have a control group to compare against, so whether opioid usage was down at other hospitals not participating in the initiative was not measured. Also, the results of the initiative did not assess patient satisfaction, which would show whether the opioid alternatives were comparable to opioids in managing pain (Ragan, The Greeley Tribune, 1/25; Ingold, The Denver Post, 1/26).

Next: How to combat the opioid epidemic

Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.

This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.