Hospi­tals to limit opi­oid pre­scrip­tions for acute pain

St. Thomas Times-Journal - - LOCAL NEWS - JENNIFER BIEMAN

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.

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