by Erik Verzemnieks, MD
Featured in the July/August 2018 Colorado Medicine.
Reducing our reliance on opioids is more than simply saying “stop.” Providing alternatives to providers is essential. At Swedish Medical Center, our emergency department has implemented a set of opioid-alternative pathways to give providers the tools to treat pain effectively but also expose fewer patients to the potentially harmful effects of opioids.
Many conditions have more effective analgesic options than opioids, making implementation common sense. Intravenous lidocaine combined ketorolac is an effective way to control the pain of renal colic. Musculoskeletal pain, including back pain, can be treated with ketamine, lidocaine patches, and trigger point injections. In headaches, opioids can be detrimental, and there are many effective options ranging from simple high-flow oxygen to haloperidol and valproic acid.
Though there is an emphasis on opioid alternatives, opioids do have a continued role in pain control in the emergency department. But with multiple alternatives now available to our providers, we are beginning to see many fewer indications where opioids are first-line or even required.
Now we are not alone in this endeavor. Several other emergency departments and hospitals throughout the state have joined in a pilot study to assess the effectiveness of these alternative pathways. These include Boulder Community Health and BCH Community Medical Center Emergency Room, Gunnison Valley Health, Medical Center of the Rockies, UCHealth-Greeley Emergency and Surgery Center, Poudre Valley Hospital, UCHealth Emergency Room-Harmony, Sedgwick County Health Center, Sky Ridge Medical Center and Yampa Valley Medical Center. It will be exciting to see the results of these interventions as we all work to fight the opioid epidemic and provide better care to our patients throughout Colorado.
For those interested in learning more about these pathways, read the most recent Colorado ACEP 2017 Opioid Prescribing and Treatment Guidelines. Find the guidelines online: www.coacep.org.