Sharply Reduced Opioid Use in 10 Hospitals

• The opioid epidemic is in all the news.
• What to do about this crisis?
• Alternative procedures tested in Colorado.
• Startling results.

THE OPIOID EPIDEMIC IS IN ALL THE NEWS. In the US last year, opioids (including prescription opioids, heroin, and fentanyl) killed more than 42,000 people, more than any year on record. 40% of all opioid overdose deaths involve a prescription opioid (report by CDC).

I recently wrote two blogs on opioids: One about a family struggling with a son’s addiction (click HERE), and the second a horrendous story about two opioid addicts but with a positive ending (click HERE).

WHAT TO DO ABOUT THIS CRISIS? The federal government held a big meeting with many stakeholders last week. There were complaints about not enough action (or money) by the feds. But I heard yesterday about a state-initiated solution on National Public Radio (NPR), and it seems like something to get excited about. The bullets below are taken from an NPR presentation (click HERE):

Ashley Copeland (right) talks to her mom Sue Iverson in the Swedish Medical Center emergency department, near Denver. Copeland got a nerve-blocking anesthetic instead of opioids to ease her severe headache. At discharge she was advised to use over-the-counter painkillers, if necessary. John Daley / CPR News. Click to enlarge or to source.

• One of the most common reasons patients head to an emergency room is pain. In response, doctors may try something simple at first, like ibuprofen or acetaminophen. And, if that isn’t effective, the second line of attack has been the big guns – “Percocet or Vicodin,” says Dr. Peter Bakes, an emergency medicine specialist at Swedish Medical Center in Englewood, Colo. “Medications that certainly have contributed to the rising opioid epidemic.”
• Ten Colorado hospitals, including one called Swedish, participated in a six-month pilot project called the Colorado Opioid Safety Collaborative, aimed at cutting their use of the prescription painkillers.
• Dr. Don Stader, an emergency physician at Swedish who helped develop and lead the study, says the institutions cut their use of the drugs by 36 percent.
• The overall decrease amounted to 35,000 fewer opioid doses than were prescribed during the same period in 2016.

THE APPROACH INTRODUCES ALTERNATIVE PROCEDURES — using nonopioid patches for pain, for example. Another innovation, Stader says, is using ultrasound to help guide targeted injections of nonopioid pain medicines.
• Rather than opioids, such as oxycodone, hydrocodone or fentanyl, Stader says, the doctors now try to use safer and less addictive alternative medicines, like ketamine and lidocaine, an anesthetic commonly used by dentists.

Dr. Don Stader is associate medical director at Swedish Medical Center in Englewood, Colo., and a consultant on opioid use for the Colorado Hospital Association. “We all see the carnage that this opioid epidemic has brought,” he says. “And we know that we have to do something radically different.” John Daley / CPR News. Click to enlarge or to source.

LIDOCAINE WAS BY FAR THE LEADING ALTERNATIVE — its use in the project’s ERs rose 451 percent.
• “Because they haven’t had the experience of that multifaceted care, patients don’t expect that ibuprofen is going to work, or that ibuprofen plus Tylenol, plus a heating pad plus stretching measures — they don’t expect that to work.”
• “And I think if we did put this into practice in Colorado, and showed our success,” he says, “this would spread like wildfire across the country.”

This story is part of NPR’s reporting partnership with Colorado Public Radio and Kaiser Health News. John Daley can be found on Twitter @CODaleyNews.

TO PUT THE OPIOID CRISIS IN PERSPECTIVE, here are some USA statistics: opioid deaths were 42,000 on 2016. In comparison, more than 58,000 US soldiers died in the entire Vietnam War, nearly 55,000 Americans died of car crashes at the peak of such deaths in 1972, more than 43,000 died due to HIV/AIDS during that epidemic’s peak in 1995, and nearly 40,000 died of guns during the peak of those deaths in 1993.

TAKEAWAY. The above study shows that in western medicine there are alternatives to opioids for pain. Perhaps not for the most intense pain, but this approach surely seems worth trying.

Plus there is alternative or eastern medicine, as studied extensively by Dr Andrew Weil, for example (see HERE). I myself have been taking for 2-3 years a combination of turmeric and glucosamine for serious arthritis in one hip and am convinced it stops the pain from getting worse.

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The Gray Nomad ….. Look after yourself.
Conventional doctors over-prescribe drugs. This is due to (1) massive advertising of drugs, (2) a perception that a patient needs a drug to heal, and cannot heal without a drug.     [Dr Andrew Weil].

It is the heart which perceives God and not the reason. That is what faith is: God perceived by the heart, not by the reason.
[Blaise Pascal…..physicist, mathematician, philosopher in the 1600s]

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6 years ago

Thanks again Ian, good and informative blog. Recently five doctors in NY were charged for taking very large kickbacks for over prescribing opioids. Maybe this will put more doctors on notice. As most people know, overuse of ibuprofen and acetaminophen is a primary causes of kidney and liver transplants. Pain… friend or enemy? Depends. I have had my share of pain in the past few years, but I stayed away from the opioids. Glad I did.

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