Northern Colorado hospitals crack down on pain medications amid opioid crisis

Saja Hindi
The Coloradoan
Pharmacy Technician Alicia Muro places bottles of pills on their proper shelves between filling prescriptions at Poudre Valley Hospital on Wednesday, Nov. 1, 2017. The hospital is among a handful of UCHealth facilities working to reduce the number of opiate-based prescriptions it fills for patients.

Northern Colorado leaders are looking to find their own solutions after the president's declaration last week that the opioid epidemic is a public health crisis.

In the past two weeks, Northern Colorado has had at least three overdoses from prescription medications, and one resulted in death, said Dr. Eric Olsen, a UCHealth emergency physician based at Medical Center of the Rockies in Loveland.

He said that's preventable, and it starts at the doctor level.

A statewide pilot program is working on reducing the number of opiates that leave hospitals. Eight Colorado hospitals and three free-standing emergency rooms are in their final weeks of the six-month Opioid Safety Pilot Program, which began in June.

Olsen is spearheading the program in the health system's emergency departments.

"When people come in for a painful situation and ... let's face it, just about everybody comes into the ER because of some type of pain ... there's a lot of opportunities to try and help the person and try to alleviate pain without jumping to opiates first," Olsen said.

The pilot program is collecting data that will be reviewed at the end of the six months, but is also part of a retraining process of emergency room and other doctors.

"The alternative programs are series of treatment options that we can do to get the same results ... to adequately treat pain without using these very powerful and very addictive ... opiates," he said.

Olsen said he often thinks of the phrase: "Nobody has ever died from pain by itself, but people have certainly died from the treatment of pain."

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The goal of the study is to reduce prescriptions for opioid-based pain medication by 15 percent across all the hospitals and emergency rooms participating, and Olsen said in most, they've already far exceeded the goal.

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Prescribing rates by county, 2016
Prescribing rates by county, 2012

"We really have to educate the non-emergency room doctors because honestly, that's where the excessive number of prescriptions are being written," he said.

Olsen said the study has had an impact on doctors.

"One of the nice offshoots to this study is it's been a great eye-opener and great awakening ... this problem happened probably because of us," he said.

But he added: "If we helped develop it, we can certainly help get rid of it."

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It takes only about three days for a person to start having a physical dependence on some of these drugs, so even a reduction in the amount prescribed could make a difference, Olsen points out.

Getting realistic 

The other branch of the study, Olsen said, is the "do no harm" portion. While he acknowledges that they would love for no one to ever abuse drugs, it's not realistic.

So another focus is on providing Narcan, informing people where to get clean needles and asking them to make sure if they are going to use drugs such as heroin to do so around others.

The goal, he said, is to eventually get the state Legislature on board to allow for people to get access to Narcan for free.

This is not an issue that's unique to Northern Colorado. Some cities, such as Denver, are looking at potential solutions such as setting up supervised injection facilities, so they at least know people who are using will remain around other people in a more controlled environment.

Olsen said Larimer County doesn't have the same issues with heroin as larger cities such as Denver, but any solutions that can help people use drugs more safely with a goal of eventually not using them should be considered.

State and national efforts

At the state level, regulators and the Centers for Disease Control and Prevention have set guidelines to encourage doctors to reduce the number of opioid prescriptions.

At the state Legislature, an interim committee called the Opioid and Other Substance Use Disorders Interim Study Committee was formed to study the issue and bills that could help address the state's needs.

And Colorado health clinics received federal grant money to make buprenorphine-naloxone, which is supposed to reduce cravings and attempts at getting a high, more available.

What it's going to take to make a true impact, Larimer County Sheriff Justin Smith said, is all of the players working together.

"There's no silver bullet that's going to change things," he said.

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While he notes that the medical field has over-relied on prescribing opioid medication to patients, there are other areas that need to be addressed. That includes making changes at the congressional level and no longer allowing pharmaceutical companies to continue their "questionable practices" and lobbying to keep the Drug Enforcement Administration at bay. It also means holding insurance companies more accountable when they pressure doctors to prescribe opioids so patients don't come back for additional appointments.

"The public is right to hold their feet to the fire," Smith said.

Law enforcement's role

The Northern Colorado Drug Task Force, under the leadership of the Larimer County Sheriff's Office, is aiming for a renewed focus on busting large drug suppliers and partnering with local agencies as well as the DEA.

"If we help the cost of illegal drugs increase, then we're helping reduce (overdoses)," Smith said. "The more enforcement we do, the more we can whittle down the supply."

Part of the work the multi-agency group will conduct includes providing resources for individual agencies to address the smaller drug suppliers in their cities and towns. And, Smith said, the group plans to put an emphasis on education.

"We fail the public if we don't educate them on the cases out there," Smith said.

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In the meantime, police, along with other emergency responders, now carry Narcan, a medication used to reverse the effects of opioids in overdose situations.

Smith, however, is wary of supervised injection facilities. He says society as a whole needs to focus on the root cause of the issue.

But reducing the opioid overdoses is going to require something else, too, he said: a shift in attitudes on drug use. 

Legal marijuana and opioids

A new study slated for publication in the American Journal of Public Health in November suggests that the legalization of marijuana is associated with a slowing of prescription opioid overdose deaths in the state.

But officials say it's too soon to tell.

Larimer County Sheriff Justin Smith says a number of factors could have led to a decrease in opioid deaths, such as a change in prescription laws, the use of Narcan, or even people switching to heroin.

"I don't believe there's any evidence there," he said. 

He points out the study focused on legal recreational marijuana use, not medicinal.

The Colorado Department of Public Health and Environment told the Denver Post it's too early to draw such conclusions.

By the numbers

In 2015, Colorado had 329 reported deaths due to opioid overdose, making up about 38.8 percent of drug overdose deaths, according to the Colorado Department of Health and Public Environment.

And though the number of prescription opioid deaths decreased in 2016 to 300 from 338 in 2014, the number of deaths from heroin — an illegal opioid — increased.

Nationwide, the epidemic has claimed the lives of about 64,000 Americans last year, about 175 people per day.

A final report by the president's opioid commission is expected to be released this week with more details surrounding President Donald Trump's plans.

Reporter Saja Hindi covers public safety and local politics. You can follow her on Twitter @BySajaHindi or email her at shindi@coloradoan.com.

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