Colorado hospital pilot reduced opioid use by focusing on alternative pain therapy in the ER

10 emergency providers piloted guidelines that encouraged greater use of opioid alternatives. (Pixabay)

A Colorado pilot aimed at encouraging emergency providers to use more alternatives to opioids led to significant decreases in opioid prescribing since its launch last year. 

The Colorado Hospital Association conducted a six-month pilot (PDF) in eight hospital emergency rooms and two freestanding ERs in June 2017, implementing guidelines developed by the state's chapter of the American College of Emergency Physicians that encourage doctors to use alternatives to opioids as frontline treatements. 

The 10 pilot participants reduced opioid administration by 36% compared to the same time period in 2016, a reduction of 35,000 individual opioid administrations. In tandem, administrations of non-opioid alternatives increased by 31.4%.  

The pilot's reductions far outstripped the initial 15% goal, and the results suggest that the program could be implemented statewide to combat the opioid crisis, the CHA said in an announcement. Colorado has the 12th-highest rate of prescription opioid misuse and abuse in the U.S. 

The guidelines (PDF) also push emergency providers to better flag patients who may come to the ER with signs of addiction or who are at high risk of becoming addicts. Doctors should avoid prescribing long-term opioids to patients with acute pain, and patients who do get opioid prescriptions should be warned of the addiction risk, the guidelines suggest. 

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"The potential that opioid prescriptions carry for addiction and abuse made the need for these guidelines clear," Don Stader, M.D., an emergency physician at Swedish Medical Center in Denver and secretary of Colorado's ACEP, said in the announcement.  

"My colleagues and I are very excited by the pilot results. It appears that we are one step closer to solving the opioid crisis in Colorado," he added. 

Hospitals have had to take a second look at how they treat pain in the wake of the nationwide opioid epidemic. In Nashville, for example, as they work to reduce opioid prescriptions, hospitals are now warning patients they may face some pain postsurgery. 

Some clinicians are trying a multidisciplinary approach that combines a number of alternative therapies, though many doctors struggle to strike the right balance between what patients demand and what's best for them. A number of healthcare organizations, like the Joint Commission, have weighed in to offer guidelines and best practices.