Docs at forefront of tackling opioid crisis

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Halfway through Dr. Sean Donahue’s shift in the emergency room, another call comes in for an opioid overdose.

It’s the third of the night for the UCHealth Memorial Hospital emergency medicine physician.

“It was all those overdoses and car wrecks with victims caused by drivers using narcotics, like almost two or three a shift, that made us [doctors and administrators] realize something needed to change,” Donahue said.

Reducing the number of prescribed opioids became one of the emergency department’s top priorities.

“We really spearheaded this movement about three years ago,” Donahue said. “I think we all came to a consensus as leaders that what we had been doing wasn’t working at all.”

Now, emergency departments across Colorado are following in Memorial’s footsteps in attempting to reduce opioid prescriptions.

“Memorial has been a leader in this effort and has seen a targeted reduction in the number of opiate prescriptions provided in the emergency department,” said Mark Mayes, the hospital’s emergency department service line director, in an email. “From calendar year 2015 to calendar year 2016, we decreased the number of pills prescribed by 68 percent.”

Last year, the Colorado Hospital Association launched its Opioid Safety Pilot, which was a six-month effort to decrease opioid administration in 10 hospital emergency departments.

“The association worked to ensure that the departments selected covered a wide variety of communities and facility types,” said Cara Welch, director of communications for the organization, in an email. “For example, there were sites in the Denver metro area and also in rural Colorado. There was a Level I Trauma Center as well as freestanding emergency departments.”

The pilot’s alternative to opioids (also known as ALTO) protocols were included in the Colorado Chapter of the American College of Emergency Physicians 2017 Opioid Prescribing & Treatment Guidelines.

“These protocols recommended other medications and treatments to use to treat common pain pathways seen in the emergency department, such as for headaches, kidney stones and abdominal pain as a first-line treatment, with opioids only being used as a ‘rescue medication’ when needed,” Welch said.

The 10 departments achieved an average 36 percent reduction in the administration of opioids during the trial while increasing their use of alternatives by 31 percent.

Because of the success of the pilot program, now called the Colorado ALTO Project, Welch says the association is rolling it out to all Colorado hospitals throughout the year.

“The association has also been sharing resources with other hospitals and organizations across the country, as this was the first project of this kind to demonstrate success across all types of hospital emergency departments,” she said. “There is federal legislation that would provide grant funding for hospitals seeking to implement a similar program to the CHA pilot.”

Welch said several Colorado legislators support the government funding, including U.S. Senators Michael Bennet (D) and Cory Gardner (R), and Representatives Diana DeGette (D) and Scott Tipton (R).

“The association has worked closely with its more than 100 member hospitals and health systems across the state to understand what the hospitals are already doing and how the association could assist in furthering efforts to address the opioid epidemic in our state,” Welch said.

According to the CDC, opioid prescriptions peaked nationally in 2012 with a rate of 81.3 prescriptions per 100 persons.

The country’s opioid prescription rate decreased for four consecutive years starting in 2012.

Two years ago, it had fallen to the lowest it had been in more than 10 years at 66.5 prescriptions per 100 persons, which equated to roughly 214 million total opioid prescriptions.

“Prescribing rates for opioids vary widely across different states and counties,” the federal agency states on its website.

El Paso County’s rates also declined from 2012 to 2016 after peaking at 79.4 in 2011.

That same year, Huerfano County in south Colorado, had a 120.1 prescribing rate. The rural county is among hundreds of municipalities and states nationwide suing opioid suppliers.

Several law firms have contacted El Paso County about joining in litigation, said Dave Rose, chief public information officer for the county, in an email.

“The county has not requested or received any formal proposals from these firms,” he said.

Commissioners directed the county attorney’s office to request relevant data from the district attorney and sheriff.

“The commissioners want to have that verifiable ‘cost to county’ information to evaluate possible participation in any of these lawsuits,” Rose said. “They recognize that the expense of litigation is built into the costs of almost everything and certainly adds to the cost of medication, so the commissioners have indicated that they do not wish to engage in any lawsuit without a full accounting of the actual costs to the county.”

It also would be useful to have information currently being compiled by the city and county of Denver, which are researching ways to determine actual opioid-related costs to municipalities.

“At the same time, they both are taking the lead on researching various options for Colorado counties and cities, either in joining one of many pending lawsuits or filing a separate action,” Rose said.

Meanwhile, data from the El Paso County Coroner’s Office indicated a roughly 50 percent jump in opioid deaths from 2013 to 2014.

The trend continued with a 24 percent increase in 2016, which had a total of 120 opioid deaths, compared to the previous year.

Donahue said it might take a while to see the benefits of the opioid-reduction programs, and in turn, a slide in opioid deaths, due to the narcotic’s black market availability.

“I think our program has helped reduce the amount of opioid overdoses, but that’s hard to prove because people can still get them elsewhere,” he said. “For us, a big part is just knowing people are not getting the narcotics from us. It’s still us cutting off one of the big supplies.”

Welch expects overcoming the opioid epidemic will take a variety of measures.

“By looking at how frequently opioids are used in the emergency department, we can address the front-end of the epidemic — meaning the way that a person may first experience opioid medications and be at risk for a future addiction,” she said. “There are certainly other areas that also will impact this front-end issue, such as primary care, surgery, dental, but for the hospital — the emergency department is the main location for patients with moderate to severe pain, and treatment with opioids had been common practice.”

Additionally, it will take multiple partners to tackle what has become a public health concern.

“Hospitals can play one role, but providers, community partners, law enforcement and treatment will also have to be involved,” Welch said. “We as a community and state will all have to work together to address issues along that entire continuum to truly turn the tide on this epidemic.”

Dr. Robin Johnson, medical officer for clinical and community partnerships at El Paso County Public Health, says the municipality follows state and Centers for Disease Control recommendations, which state: “Collaboration is essential for success in prevention [of] opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance abuse treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic.”

Editor’s note: The Business Journal reached out to Penrose-St. Francis Health Services for this article but didn’t receive a response before press time. Learn about the the Business Journal’s upcoming opioid event here.

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