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Doctors hope to create ‘revolution’ in opioid crisis

Pilot program across Colorado has focus on finding alternatives


Opioid misuse is at an all-time high and doctors are part of the problem — and, hopefully, the solution.

That’s according to those participating in a new program in Colorado aimed at stopping opioid abuse.

“Medicine as a whole is starting to look at the mistakes of our past — to look at the fact that we have been over-prescribing these medications,” said Dr. Don Stader, an emergency physician at Swedish Medical Center in Englewood. “A clinician’s desire is to do well by our patients. We never want to see our patients suffer if we can help it, but now we are seeing that (opioids) are a short-term solution with lots of long-term, adverse effects.”

Stader, chair of the American College of Emergency Physicians opioid task force, is part of a state pilot program started by the Colorado Hospital Association that seeks to combat the way pain is treated with opioids in hospitals, especially in emergency rooms.

Eight hospitals, including Swedish and Sky Ridge Medical Center in Lone Tree, and three free-standing emergency departments across Colorado are participating.

The program’s goal is to lower the number of opioids prescribed at the pilot locationsby 15 percent.

“We are on the leading edge in creating this program in Colorado,” said Dr. Adam Barkin, chairman of emergency medicine at Sky Ridge Medical Center. “A study like this has not been this widespread anywhere in the country.”

Alternative treatments

Opioids are synthetic or partially synthetic manufactured drugs that mimic the properties of opiates, such as OxyContin and Vicodin. Opiates are drugs directly derived from the poppy plant, such as morphine and codeine.

The Centers for Disease Control and Prevention counted 15,000 overdose deaths from prescribed opioids in 2015. Stader believes today’s opioid problem started 20 years ago when there was a rise in opioid-prescribing patterns. Opioids are prescribed four times more often today than they were in 1999.

“Opioids over the last 20 years have been used for more and more minor conditions,” Stader said. “People over the last 20 years have been getting Percocet for ankle sprains. We never used to use opioids for these conditions in the past.”

Stader and Swedish Medical Center pharmacist Rachael Duncan created a program called ALTO, or Alternatives to Opiates. This program created medication guidelines that pilot clinicians will use to treat specific types of pain in place of opioids.

“We are looking to understand if we can prove the accuracy of alternatives to opioids,” said Diane MacKay, clinical manager for the Colorado Hospital Association.

The Colorado Hospital Association is hoping the pilot will expand out of Colorado.

“This is about what we can do, not just in the state of Colorado but across the nation, to take responsibility for this epidemic and to offer a solution,” MacKay said. “We want to get doctors and nurses really excited about this.”

An important approach to the future treatment of pain, Stader said, is how those in the medical field look at pain. The goal is not to immediately eliminate pain, but instead to manage pain so people are comfortable enough to function in their daily lives.

“Pain is sometimes appropriate and people may need to weather it for a bit,” Stader said.

‘A revolution’ in pain control

Training, which started in the spring, is a vital part of the pilot program. Stader has created podcasts and videos, and conducts on-site training.

“We will communicate about our strategies as well as make sure we all understand what we are doing,” Barkin said. “That trickles up into the entire hospital. It is key for there to be education surrounding this effort. If it is isolated, then we will never achieve the success that we are going for.”

The doctors involved in the pilot are passionate about reversing the opioid prescription trend to better serve their patients.

“What we really want to do is create a revolution in how we control pain,” Stader said. “This is a crisis that medicine has created and a crisis that medicine has to solve.”


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