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As the overdose epidemic in Colorado continues, hospitals are taking a new step to dramatically reduce opioid prescriptions

Opioids still account for 8 percent of all prescriptions in Colorado

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Colorado’s drug overdose epidemic raged onward in 2018, claiming more lives than car crashes, according to state figures, despite the work of government officials and medical professionals furiously trying to slow it down.

But one of the foremost experts on Colorado’s epidemic sees cause for optimism.

“It’s getting better,” said Rob Valuck, the director of the Colorado Consortium for Prescription Drug Abuse Prevention. “I wouldn’t say it’s great. But it’s getting better.”

The reason for Valuck’s hopefulness lies at the trailhead of what he views as a path from doctor’s office to addiction to overdose. Since 2014, the number of opioid prescriptions written annually by Colorado physicians has dropped by more than 200,000 — from more than 4 million to less than 3.8 million. A pilot program launched 18 months ago to reduce opioid use in emergency departments resulted in participating ERs cutting their opioid prescriptions in half.

But opioids still make up about 8 percent of all prescriptions in Colorado. So, now, Valuck and others are hoping that a new campaign can take the opioid-reduction strategies from the ER program to the rest of the hospital. The idea is to bring together dozens of specialty doctors’ groups — associations for anesthesiologists, for instance, or urologists — and get them working on protocols for first trying other pain therapies before going to opioids.

“Everybody has a role in this and we want to tap into that collective expertise,” Valuck said at a symposium last week hosted by the Colorado Hospital Association where the new effort was announced.

Empty pill bottles cover the Opioid Memorial Wall, part of a Colorado campaign called Lift the Label aiming to reduce the stigma around addiction in order to encourage treatment and recovery. (John Ingold, The Colorado Sun)

“This is a huge deal,” said Dr. Darlene Tad-y, who works as a physician adviser for the hospital association. No other state in the country has made such a coordinated effort to write opioid-reducing protocols, she said.

“It is the way we are going to end the opioid epidemic here in Colorado.”

New guidelines for a new approach

The policies coming out of the effort will be individualized for each specialty, Tad-y said. So urologists will work with different instructions than anesthesiologists. But everything will be built around four pillars: reducing the prescription of opioids; increasing the use of alternate therapies; giving patients who are addicted to opioids access to medication that is less harmful, like methadone; and making sure every patient who needs longer-term addiction treatment gets it.

Hospitals long over-relied on opioids to treat pain, Valuck said.

“It had just gotten to the point where, whatever pain you had, you were getting Vicodin,” he said.

Under the new guidelines that will come out of this program, though, doctors throughout hospitals and clinics might first try treating pain using an anesthetic like lidocaine or recommending a rotation of Tylenol and Advil. Studies have shown that the latter combination can be as or even more effective than opioids. But Dr. Caitlin Dietsche, an internal medicine specialist at the University of Colorado Hospital, said patients have sometimes been wary of taking over-the-counter medicines for serious pain.

“It turns out,” she said, “if we’re not using these things, we’re effectively telling patients they don’t work or they’re not enough. But they often are enough.”

MORE: The opioid crisis is breaking hearts in Colorado — and that’s forcing doctors to make tough choices

Dietsche, though, said doctors can sometimes also have the opposite problems — patients who want something other than opioids, leaving the doctor at a loss for what to prescribe. For that reason, she said the forthcoming protocols will aim to be as streamlined as possible, providing doctors a list of non-opioid treatment options for a given medical condition. Tweaked back? Try massage or acupuncture instead of narcotics.

The goal is to remove the guesswork and indecision.

“It actually takes more thought to use ALTOs than opioids,” she said, using the medical-lingo acronym for alternatives to opioids.

“We’re all addicted to something.”

But, so far, hospitals that moved away from prescribing opioids say patients in pain haven’t suffered as a result.

Centura Health implemented an ALTO program across its 17 emergency departments in December after seeing the results from the hospital association’s pilot program. Now, for something like abdominal pain, for instance, the hospital might use drugs that treat heartburn or nausea in combination with Benadryl.

That doesn’t mean opioids are never used as a treatment option. They just aren’t the first thing Centura’s patients are pointed to.

“It really does take a while to get providers to think differently,” said Mary Beth Savory, a nurse at Centura who is coordinating the provider’s opioid response. “We’re all addicted to something, and the addictions to writing prescriptions one after the other is easier sometimes than just having a conversation with patients.”

Valuck said getting doctors to think of opioids as drugs that should be prescribed only in limited circumstances is a big step forward in stopping the epidemic, even though overdose deaths continue apace.

Last year, at least 841 people died of a drug overdose in Colorado, including at least 464 who died from an overdose of an opioid or heroin, according to numbers from the Colorado Department of Public Health and Environment. Those numbers are just preliminary, though, and they will almost certainly increase as coroners finalize death certificates for overdoses that occurred near the end of the year.

Valuck said he believes there was little to no reduction of deaths in 2018 compared to 2017, and some areas — such as deaths from cocaine or fentanyl — already show increases for 2018 compared to the previous year. That indicates how the epidemic has morphed into a broader crisis as people who first became addicted to prescription drugs now fight withdrawal using whatever they can find.

Valuck said the state must do a better job providing treatment to those already suffering from addiction — “treat a medical condition like a medical condition,” as another doctor put it at the hospital association’s symposium. But the hospitals’ efforts to shut down the flow of people being prescribed opioids to begin with is just as important.

“We think we are going to make the biggest impact if we collaborate,” he said.

Staff writer Jesse Paul contributed to this report.

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