Amid national opioid epidemic, hospital evaluates practices

By Adam Strunk

The fewer opioids the community takes the better.
That’s the message Newton Medical Center is working to send to the community with a multi-month review of its prescription methods for the addictive pain killing drugs and the monitoring and education actions it takes with its patients. A spike in opioid addiction nationally prompted the action. 

We realize it’s a national problem that’s huge in other states,” Orthopedic surgeon Charles Craig said. “It’s not quite as much of a problem in Kansas, but we’re worried that it could come here and could be worse here.”

In 2016, states such as West Virginia and New Hampshire had opioid related death rates of 41 deaths and 35 deaths per 100,000 deaths. According to the national institute of drug abuse, in 2016, 5.1 out of 100,000 Kansas deaths were caused by opioid overdose, below the 13.3 national rate. According to Newton Medical Center, the hospital treated 14 patients for an opioid overdose in 2018.

Opioid addiction, labeled by the government as a national crisis, has grown since the early 2000s. Pharmaceutical companies, such as Purdue Pharma, have paid out hundreds of millions of dollars in settlements and faced snowstorms of lawsuits and legal action for promoting wide spread use of the treatments as safe and non-addictive, while the companies knew otherwise. The use of strong opioids, with the same addictive chemical ingredients as morphine, expanded in medical use during the time period.

Craig said that since the time, many medical doctors have worked to decrease the reliance on opioids.

Previously, we certainly used them more, like around (the year) 2000,” Craig said. “As we learned more about the addictive potential, we’ve all tried to cut down on use.”

Craig authored a recently released review of Newton Medical Center’s own prescription practices with opioid narcotics.

The recommendations of the review, published by the hospital, contain reducing opioid usage through increased monitoring and tracking, improving patient education about prescribed drugs and encouraging alternative pain management practices.

On the reduction side, Craig said in his area of practice of orthopedics, doctors are switching to a “multi modal approach” in recent years. He explained that in orthopedics, patients are often given anti-inflammatory drugs now before operations, and non-addictive treatments for nerve pain, such as Gabapentin are now administered.

Post op, we try to limit the amount of narcotics we give to patients,” he said. “We want to get them off, as soon as possible.”

He said prescriptions are now more limited.

By in large, we seldom give very many, maybe 20-30 (pills) post op,” he said. “The more you give them (patients) of those narcotics, the more likely they are to start to become addicted. Extended out to 2-4 weeks, if they are still using significant amounts of narcotic, I’d start getting worried.”

Short-term or acute pain is easier for medical professionals to deal with. Chronic pain constitutes increased difficulty, because often, pills are taken for a longer period of time outside a medical setting.

Craig said that in cases of people whose pain persists, doctors at Newton Medical Center have the option of referring them to a pain specialist better suited to handling pain management or the root of the pain. They also have the ability to now check with a state service KTRAC, to see if the patients are gaining pain medications in other places.

Craig said doctors at the hospital can now enter into pain management plans with patients about how they use pain medication. If patients violate the contract and seek additional medication from medical providers, doctors have the option of no longer prescribing additional medication.

He said locally, pharmacists also help the hospital out, contacting doctors, if they are often filling prescriptions in a short period of time for the same user from multiple health care providers.

It should be noted that the hospital puts pain, caused by terminal illnesses, such as a cancer, in a separate category, noting that in such cases of extreme pain, opioids are necessary for the humane treatment of patients.

Part of the reviews recommendation will be basic education about the effects of opioids that users are prescribed and discussions on how to use the pills. The hospital has posted that information on its website, as well as a list of questions patients should ask their doctor if they are being prescribed with opioids.

The review also suggests that the hospital continue to encourage alternative pain relief, such as physical therapy, anti-inflammatory drugs (NSAIDs) and additional comfort measures, such as ice packs, re-positioning, movement and staff presence.

Craig said the hospital isn’t necessarily pushing for a specific quantitative amount to decrease opioid pill usage, but to provide options and encouragement to staff and the public to try to prevent the problem of opioid addition from growing.
“Part of this is to alert the public and our staff to a problem that may be growing in the state,” he said.

Craig said overall, patients shouldn’t notice a huge change in hospital care.
“Many use medicines, appropriately. It raises the awareness that there’s a problem out there. For those individuals that need to rethink the amount of medication they’re taking, there’s help for that. More and more, we want our patient population to be actively involved.”