How should hospitals reduce opioid prescriptions?

New study found wide variation among different locations

Which government hospital a veteran in chronic pain walks into greatly determines whether that veteran will walk out the door with a prescription for opioids, according to a new study that provides valuable insight for hospitals looking to reduce their prescriptions of addictive painkillers.

The study examined prescribing rates at 176 U.S. Department of Veterans Affairs hospitals and clinics across the country. Because the VA is a national health system, the hospitals might be assumed to have uniform prescribing patterns.

But, when looking at the treatment of more than 1 million veterans with chronic pain, the study found wide disparities in how often the veterans were started on long-term opioid therapy, depending on the hospital.

Hospitals that offered more access to alternative pain treatments, such as physical therapy, yoga or acupuncture, also had lower rates of starting patients on long-term opioid therapy.

Hospitals that did not as consistently offer those services — or hospitals that also prescribed nonopioid medicines at high rates — were more likely to start patients on long-term opioid therapy.

“It may be something about facilities’ and providers’ comfort with prescribing as a tool,” said Dr. Joseph Frank, a University of Colorado School of Medicine professor who co-authored the study. Frank also works as a primary care doctor at Denver’s VA hospital.

The study adds to a growing body of evidence that suggests alternative treatment options are able to carry at least some of the pain-treating load that doctors currently rely on opioids for.

A recent Colorado Hospital Association program that encouraged hospitals to use opioid alternatives in their emergency departments, for instance, resulted in a 36 percent drop in opioid use in those departments.

And Frank said the results of his study could be useful to all hospitals as they seek to reduce their dependence on opioids for treating persistent pain.

“I’m confident this is not a VAspecific issue,” he said. “This is a health care-specific issue and a chronic pain issue.”