Through an initiative started in June 2018, Texas Health Presbyterian Hospital Denton used 46% fewer opioid doses in the emergency room and wrote 54% fewer prescriptions for home use, according to a press release.
For Medical City Denton, Medical City Healthcare’s chief medical officer Miguel S. Benet said in a written statement that they’ve seen “reduced utilization of opioids in our emergency departments (ED) and operating rooms because of these ‘alternative to opioids’ programs (ALTO and ESR).” ALTO refers to Alternatives to Opiates program and ESR refers to Enhanced Surgical Recovery.
“The drop in the ED has been around 21% for the Medical City hospitals in North Texas,” Benet said in his statement.
In 2017, Texas health providers wrote 53.1 opioid prescriptions for every 100 persons, compared with the average U.S. rate of 58.7 prescriptions, according to the National Institute on Drug Abuse’s Texas Opioid Summary.
“This is our effort to try to create a reduction in our contribution to the opiate crisis in the U.S.,” Timothy Harris, Texas Health Denton’s chief medical officer, said in the release.
Instead of opioids, Texas Health Denton is opting to use Toradol, an intravenous non-steroidal anti-inflammatory, and Ofirmev, the intravenous form of acetaminophen and nitrous oxide — also known as laughing gas — to help treat pain.
“Opiates are effective and fast-acting, so it’s an easy go-to,” Harris said. “But the lessons that we learned as clinicians is that narcotics can be dangerous because of the addiction potential. We don’t want [to] give you two medical problems — a chronic pain issue and an opiate addiction that destroys lives, careers, families.”
And through the initiative to reduce opioid use, Texas Health leadership “agreed on a treatment algorithm to avoid opiate prescriptions for six kinds of pain: dental, back, musculoskeletal, abdominal, headaches and kidney stones,” according to the release.
“We just wanted to be more responsible,” said An Nguyen, the medical director of the emergency room at Texas Health Denton. “This is something that has been thought of in the east coast ... so this is nothing new.”
Nguyen said the initiative has not affected the level of care at all.
“If anything, it has improved the level of care because most patients do not care about what you give them for pain ... the vast majority of the time as long as we keep them comfortable with any modality, they are fine with it,” Nguyen said. “So it has actually improved the level because we are using all the medication [and] we have been more responsible with it. So we are not causing additional harm to our patients.”
The initiative is part of a pilot program for Texas Health Resources, Glenn Hardesty, chairman of the opioid committee at Texas Health Denton, said in the press release.
“We have many other efforts, some at a system level and some at the individual hospital level, which are actively pursuing multiple strategies to improve the health of the communities we serve,” Hardesty said. “We established a comprehensive opioid committee to look at how opioids are used in the system and to identify areas where we can have significant impact on the epidemic.”