ALBANY — A group of 17 upstate New York hospitals, including nine in the Capital Region, are embarking on a pilot program to reduce the use of opioids in their emergency departments.
The Iroquois Healthcare Association is spearheading the $500,000 Opioid Alternative Project, which was funded in this year’s state budget as part of wider efforts to curb the state’s opioid epidemic. The regional trade organization representing upstate hospitals and health systems modeled the pilot after a successful program in Colorado.
“Emergency rooms are often the first contact patients have with opioid painkillers,” said Gary Fitzgerald, president of the association. “As such, upstate New York hospitals are in a strong position to reduce opioid use, particularly as their emergency departments provide care for increasing patient populations vulnerable and at risk for opioid abuse and addiction.”
The Colorado pilot was established last year, and involved training physicians, nurses and other staff at 10 separate emergency departments in treatments other than opioids for certain pain diagnoses, such as acetaminophen for urinary stones or ketamine for musculoskeletal pain. It didn’t prohibit the use of opioids where appropriate, but encouraged clinicians to instead try evidence-based alternatives when presented with certain conditions.
Results exceeded expectations. Participating hospitals were able to decrease opioid use in their emergency departments by 36 percent over a six-month period compared to the same period one year earlier, while simultaneously holding patient satisfaction scores steady, according to a report published this year by the Colorado Hospital Association. The goal had been to reduce opioid use by 15 percent.
In New York, clinicians from participating hospitals met last month to establish their own protocols for alternative treatments, said Jessica Morelli, vice president of the Iroquois Healthcare Alliance.
Details are still being finalized, she said, but they broadly agreed to use alternatives to opioids such as acetaminophen, ibuprofen, ketamine, lidocaine and even caffeine for diagnoses ranging from urinary stones, back pain, sprains, minor fractures and dislocations, tooth pain, headaches and abdominal pain.
The protocols will lay out a “menu” of first- and second-line therapies, she said. Second-line therapies are treatments for when first-line options don’t work.
Participating hospitals in the Capital Region include Albany Medical Center, Ellis Hospital in Schenectady, Glens Falls Hospital, Nathan Littauer Hospital in Gloversville, Saratoga Hospital, St. Mary’s Healthcare in Amsterdam, Albany Memorial Hospital, St. Peter’s Hospital in Albany, and Samaritan Hospital in Troy.
“I am excited to be part of a regional approach to curbing opioid use,” said Dr. Adam Rowden, an emergency medicine physician at Albany Medical Center. “One of the best ways to prevent opioid misuse and dependence is to decrease their use and minimize exposure to patients not currently taking them. These guidelines are evidence-based and treat pain while minimizing the risks for opioids.”
Funding for the project will go toward clinician training, as well as data collection for the duration of the pilot, Morelli said.
State lawmakers who helped secure the funding expressed hope that the pilot can eventually provide a model for other emergency departments.
“Emergency departments are on the front line of the opioid crisis,” said Assemblyman Richard Gottfried, a Democrat who chairs the Assembly health committee. “These 17 hospitals can be models for broader training of emergency physicians to utilize opioid alternatives when clinically appropriate.”
Morelli noted that the pilot applies strictly to opioid use within emergency departments, not to prescriptions that patients may leave the hospital with — though a number of hospitals have cut down on the dosage and duration of opioid prescriptions they hand out as the drug epidemic has worsened.
