Hospitals to limit opioid prescriptions for acute pain
Three days. That’s it. Southwestern Ontario’s largest hospital and St. Joseph’s Health Care London are joining forces as they roll out a plan to decrease the amount of narcotics prescribed for acute pain.
Patients at St. Joseph’s and London Health Sciences Centre with non-chronic pain — caused by fractures, broken fingers, acute appendicitis or surgeries including tonsillectomies — would get a maximum three-day supply of opioid pills under the new protocol that will be tested early this year.
“Pain management has traditionally been ‘Here’s your pill, goodbye.’ But the truth is that’s not the best way to do things,” said Dr. Brian Rotenberg, a head and neck surgeon and the vice-chair of St. Joseph’s medical advisory committee.
“In many cases, pain management has been oversimplified in terms of giving prescriptions, and people are prescribing based on historical norms, whatever they learned as a resident.”
In addition to the three-day limit, all opioid prescriptions coming from St. Joseph’s and LHSC doctors — enhanced with new tamper-resistant features — would come with an information sheet about what patients can expect pain-wise and other ways to deal with the hurt, including drugstore painkillers, heating pads and massage.
The policy shift is the work of the opioid stewardship council, an initiative that sprung from the joint medical advisory committee, the medical decision-making body at St. Joseph’s and LHSC.
Beginning in November 2017, the council set out to zero in on which hospital departments were contributing the most to the regional opioid dilemma and come up with ways to make improvements. The policy will target mostly the emergency room and day surgery departments, Rotenberg said.
Team members took a critical look at the specific opioids — and amounts — doctors in both hospitals were prescribing for acute pain and checked the most up-to-date medical literature to see if the two matched up.
“There’s not really good, strong reason why certain prescriptions were even being given out,” Rotenberg said. “The current prescribing patterns were not matching with World Health Organization standards for pain management. . . What we found is there’s a better way to prescribe.”
For most patients with acute pain, a three-day supply of opioid painkillers will do the trick, Rotenberg said.
The policy isn’t meant to do away with prescribing the potentially addictive medication, but to promote more responsible and evidence-based distribution of the drug by hospital doctors and limit the number of opioids pills in circulation.
Extra pills can sit in medicine cabinets long after the pain they’ve been prescribed for has subsided – an easy target for theft or misuse, Rotenberg said.
Reducing the number of pills in the community is key because prescription narcotics — not just hyper-potent street opioids such as fentanyl — have a role in the growing drug crisis.
A study released last summer by researchers at St. Michael’s hospital in Toronto and the Ontario Drug Policy Research Network found more than half of Ontario’s opioid overdose deaths in 2016 involved prescription drugs. A third of the deaths involved people with an active narcotic prescription.
The opioid crisis looms large in London, ranked sixth-highest in the country for opioid hospitalization rates in 2017, according to a report released last month by the Canadian Institute for Health Information (CIHI).
Addressing the regional opioid abuse and addiction issue will require co-ordinated action from many different organizations, Rotenberg said, but the joint hospital initiative is a solid step.
The changes — pill limits, information sheets for patients and anti-fraud prescriptions — are all being made through the software network used by LHSC and St. Joseph’s, Rotenberg said.
Several other hospitals in the region use the same version of the computer program.
“When we modify it here, it’s being modified for them as well,” Rotenberg said, adding the changes are in the testing phase so far. “We’ve had to go through the process of getting their approvals for this. The changes we’re making are actually going to be regionwide. . . The change here is going to be quite wide-ranging, hugely impactful.”
Dr. Brian Rotenberg, a head and neck surgeon and the vice-chair of the medical advisory committee at St. Joseph’s Health Care London, helped draft a new protocol that will limit the amount of opioids some patients are prescribed at St. Joseph’s and London Health Sciences Centre.