Opioid use down in new plan

LONE TREE» Colorado hospitals that were part of a groundbreaking pilot project were able to dramatically reduce the amount of opioids they administered by simply focusing on alternative, safer pain treatments, according to a new study released Thursday.

When the Colorado Hospital Association launched the project last summer, it set a goal of reducing opioid administration in emergency departments by 15 percent. Instead, the eight hospitals and two freestanding emergency rooms that were part of the project reduced opioid administration by 36 percent.

Every facility in the project reduced opioid use by at least 30 percent. Two facilities came close to reducing their opioid administration by half. And for two monitored conditions — kidney stones and back pain — the facilities flipped from treating them mostly with opioids to using alternatives.

When the results were presented Thursday at a Colorado Hospital Association forum on opioids, the audience applauded enthusiastically.

“Holy schmoly,” Dr. Don Stader, a Swedish Medical Center emergency department doctor who helped lead the effort, said to the crowd.

All told, Stader said the pilot program resulted in 35,000 fewer doses of opioids being administered at the participating facilities. At one point late last year, Stader said use of alternatives topped use of opioids at the facilities.

“That’s a revolutionary change in how we’re practicing medicine,” he said.

Spurred on by a crisis of overdose and addiction, the project is part of a growing effort to rethink the role of opioids in pain treatment. The hospitals and freestanding emergency rooms that participated committed to trying first to treat most patients with a broad array of drugs that fall under the heading of alternatives to opioids, or ALTOs. The drugs range from the familiar — such as acetaminophen, the active ingredient in Tylenol — to drugs like ketamine or lidocaine.

Dr. Heidi Wald, a professor at the University of Colorado School of Medicine who helped run the study, said the results come with caveats. The project didn’t have a control group, so it did not measure whether opioid use also dipped at hospitals that did not participate in the program. The results presented Thursday also did not include measurements of patient satisfaction, which would reveal whether the alternatives controlled pain as well as opioids.

The study tracked opioid administration for six different conditions. Use of opioids dropped for all six but not equally. For broken bones and cancer-related pain, opioids were still used more than three-quarters of the time.

Still, Wald said the results are encouraging, and the hospital association hopes to expand the program to more facilities.

“The ALTO approach appeared to be feasible,” Wald said.