by Debra Parsons, MD, FACP, and Darlene Tad-y, MD
Featured in the March/April 2019 Colorado Medicine.
A coalition comprising the Colorado Hospital Association, the Colorado Consortium for Prescription Drug Abuse Prevention and the Colorado Medical Society launched a new safety initiative in January. The Colorado Opioid Solution – Colorado Clinicians United to Resolve the Epidemic (CO’s CURE) seeks to create partnerships between Colorado’s hospitals and the state’s medical specialty societies to develop the nation’s first comprehensive, multispecialty medical guidelines for limiting opioid use and increasing the use of alternatives to opioids (ALTOs).
CO’s CURE will provide the resources to convene medical specialty society organizations to develop and implement new evidence-based opioid prescribing guidelines to pilot in Colorado hospitals and medical practices. The specialty-derived guidelines will be built around four pillars that all specialties can adhere to – limit opioid use, use ALTOs for treatment of pain, implement harm reduction strategies, and improve treatment and referral of patients with opioid use disorder – while also allowing the specifics of each set of guidelines to be tailored to the nuances of each specialty.
The first phase of CO’s CURE will be led by the Rocky Mountain chapter of the Society of Hospital Medicine, which represents the state’s hospitalists. The organization is currently working with the coalition to develop guidelines for hospitalists that can be piloted at a Colorado hospital later this year. This first phase will be funded by a State Opiate Response grant through the Colorado Office of Behavioral Health.
Our goal is to continue the important work that Colorado hospitals and providers have already partnered on – treating pain while also reducing harm – through the development of additional opioid prescribing guidelines. This initiative continues the successful model of having clinicians help champion the work, which accelerates the rate of adoption and sustainability. We look forward to working with our state’s specialty societies to develop and trial these guidelines and ultimately help resolve the opioid epidemic in Colorado’s communities and lower costs for the entire health care system.
In 2017, CHA, in partnership with the Colorado Chapter of the American College of Emergency Physicians (CO-ACEP), launched a six-month pilot study of the CO-ACEP opioid guidelines in 10 hospital emergency departments, which demonstrated an average 36 percent reduction in opioid administration and 31 percent increase in the use of ALTOs. By the end of 2018, those pilot sites had decreased the administration of opioids by 62 percent. The pilot has since been expanded into the Colorado ALTO Project and rolled out across the state and beyond.
CO’s CURE was launched during the second annual Colorado Opioid Safety Summit in January. More than 400 medical professionals, double the number at the 2018 event, attended the summit to address the opioid epidemic in Colorado.
As our colleague Don Stader, MD, an emergency room doctor with Swedish Medical Center, told the audience at the summit, if the only place you could get medical care was the emergency department we would have made greater improvements in the opioid epidemic.
Since that’s not the case, we must expand the program to areas where more people get medical help, like the office of their family doctor and with surgeons and dentists, to help them create guidelines of their own about opioid prescriptions so that there is a more uniform approach. The goal is to be more judicious with prescribing; opioids are no longer the first-line treatment for pain but can be used appropriately for severe pain if necessary.
All specialty societies in Colorado are welcome and encouraged to join CO’s CURE by March 15 to continue moving this initiative forward.
By providing robust support to specialty societies, Colorado can formulate the nation’s first comprehensive, multi-specialty medical prescribing guidelines that can help assure access to compassionate, evidence-based care for patients who suffer from acute and chronic pain, offer better treatment to those suffering with opioid addiction and significantly reduce the morbidity and mortality associated with opioid abuse and misuse. Together we can revolutionize the treatment of pain and improve the care of addicted patients, and serve as a model to the rest of the nation.