Hospitals focusing alternatives to opioids for pain relief
Sarah Derr of the Iowa Healthcare Collaborative stated that most hospitals in the organization's pilot program stated that their institution didn’t provide education and awareness about the safe and effective use of opioids in the community. “We can do that,” chorused GMH staff Dr. Jeff Hoffmann, Joan Parker and Robin Esmann, during Derr's presentation. (Press photo by Molly Moser)
By Molly Moser
Each day in the U.S., 1000 people are treated in emergency rooms because they’ve misused prescription opioids. Drug overdose is now the leading cause of death nationwide, and 80 percent of heroin users started out misusing prescription painkillers.
“Opioid addiction is driving this epidemic,” said Sarah Derr, PharmD, of the Iowa Healthcare Collaborative. Derr presented at the Guttenberg Municipal Hospital on Tuesday, Sept. 19.
The Iowa Heathcare Collaborative will wrap up the initial cohort program of 23 hospitals across the state, including GMH, which received resources such as a list of medication disposal sites and treatment centers in their counties, peer support in developing opioid treatment plans and coaching from expert pharmacists, among other benefits. The goal of the program is to decrease overall use of opioids and ensure patients using opioid medications have treatment plan goals including decreasing opioid use. In January, the program will be rolled out to 140 hospitals in the Hospital Innovation Improvement Network.
“Opioids are natural or synthetic chemicals that reduce feelings of pain – codeine, Vicodin, OxyContin, methadone, Diuladid, and others. They can be used for severe short-term and long-term pain, cancer and end of life comfort,” Derr said. “What we’re trying to get away from is prescribing them for just any pain, and we’re trying to educate the community.”
A large part of that education includes learning to think of pain differently, in terms of comfort level rather than a pain scale. As of Jan. 1, patient questions at GMH will change from a focus on pain management to having more discussions about patient goals. For some patients, being pain-free is not reality. Conversations will focus on meeting goals for performing daily tasks like getting dressed and using stairs, as well as on the ability to do fun things like attend sporting events or work in the garden.
Other strategies for reducing opioid use include use of other options for medication, such as Tylenol, NSAIDS like Aleve and Advil, antidepressants and anticonvulsants, which according to Derr work well for nerve pain while opioids don’t. She recommends the lowest possible dose if an opioid medication is the correct choice, and that patients cease taking the medication within 30 days. “Nationwide, a quarter of people receiving prescription opioids struggle with addiction. If opioids are taken for more than 30 days there is a 50 percent chance of addiction,” she said.
Nonmedication treatments like physical therapy, chiropractic care, acupuncture, injection therapies, TENS units and counseling are also being recommended along with alternatives like yoga, meditation, aroma and music therapy. “I think some of these alternative therapies will begin to be covered by insurance in light of this opioid crisis. Insurance is starting to limit the amount of opioids they’ll cover,” Derr told listeners.
“That’s an issue. A lot of people don’t have the time nor the financial backing to do alternative therapies,” said Dr. Jeff Hoffmann. “We also need to have the patients understand that some things aren’t immediate. Pain control is a lifestyle change.”
GMH is home to a pain clinic run by a registered nurse anesthetist. “Our doctors refer people to the pain clinic, which is very opioid aware,” said Esmann, listing physical therapy, injections, TENS units, lidocaine patches, anti-inflammatories, disposable heating pads, ice baths, and other non-invasive pain reducers.
“We are also encouraging patients to ask if there are non-opioid alternatives and whether an opioid will interact with their other medications. They’ve started asking what to do with unused opioids, and we do have disposal sites in all 99 counties. A lot of people in the community are getting ahold of opioids because they are unused and not disposed of in a timely manner,” Derr added. The Clayton County Sheriff’s office is one site for disposal of controlled substances, as are some area pharmacies. Pharmacies in Iowa can now dispense naloxone, an opioid reversal agent, without prescription.
Opioid-aware emergency departments are another area of focus for the program. Some E.R.s do not prescribe opioids, while others will prescribe a limited emergency pack and a recommendation need to see a primary care provider.
“In the 1990s under-treatment of pain was a big issue and there was lobbying for increased use of opioids. In 2000, pain was added as the fifth vital sign,” Derr explained. “We were being pushed by pharmaceutical companies and physicians were being graded on whether they could treat pain down to zero, so opioid prescribing increased. As you can see this is really something that healthcare as a whole created.”
