Inova Alexandria Hospital Emergency Room Launches Opioid Initiative to Reduce Prescription Painkiller Abuse and Overdose

Martin H. Brown, MD, FACEP, is chairman of the department of emergency medicine at Inova Alexandria Hospital. He is board certified in emergency medicine and internal medicine. Read Dr. Brown’s profile.

At the Inova Alexandria Hospital emergency department, we’ve recently launched the Opioid Initiative, a program to minimize the risks of prescription drug misuse and abuse while aggressively treating patients’ acute pain (that is, short-term pain caused by injury or illness).

Over the last decade and a half, the United States has seen an explosive increase in the use — and misuse — of prescription opioid medications. These drugs, including hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet), can be very effective for managing acute pain. But when they’re abused, they can lead to dependence, addiction and even death.

According to the U.S. Centers for Disease Control and Prevention, 44 people die every day in the United States from prescription opioid overdose. In the emergency department at Inova Alexandria Hospital, we frequently see patients who have overdosed or misused these medications. We also see others who have become dependent on these drugs and are asking us for help.

Prescription painkiller abuse is too big a problem to ignore. In November, our emergency department launched the Opioid Initiative to make sure we’re reducing risks when we’re treating our patients with pain.

A Standardized Approach to Treating Pain

In the last 15 years, sales of prescription opioids have increased 300 percent. Unfortunately, their misuse has risen hand-in-hand with the increase in prescriptions.

My colleagues and I felt it was our responsibility to take a critical look at how we treat pain in our emergency department. Through the Opioid Initiative, we aim to train our physicians and nurses on the most appropriate ways to treat acute pain.

When we looked at our prescribing practices, we were concerned that we were using certain opioid painkillers routinely, and that other, potentially safer, drug choices were available.

With the Opioid Initiative, we have developed a comprehensive policy for treating pain. The goal is to standardize our system so that all of our physicians are using a consistent, safe approach to choosing the best drugs for pain management.

Safe, Aggressive Pain Management

One step we’ve taken is to identify shorter-acting opioid medications that are less addictive than some of their chemical cousins. We’ve also identified other non-opioid options that can be helpful in treating pain.

In addition, we’ve developed guidelines about how many pills to send home with patients when we discharge them from the hospital. And for patients with chronic pain, we’re making sure to consult with pain specialists to develop safe, long-term plans for pain management.

As always, our number-one goal is to give our patients the best possible care. We will continue to treat patients’ pain aggressively. But as we do, we want to make certain that we’re doing all we can to minimize the risks of medication side effects.

Prescribing Painkillers More Thoughtfully

We’re still in the process of collecting data about the changes we’ve made. We’re looking at our physicians’ prescribing patterns and collecting information about patient satisfaction to make sure their pain remains well controlled. Already, we’ve seen a remarkable decrease in our emergency department’s use of hydromorphone (also known as Dilaudid), a potent opioid painkiller.

We expect this initiative to be an important step toward reducing the risk of opioid dependence in our patients. If the data we collect supports the benefit of the program, other hospitals in the Inova system might adopt a similar approach.

This initiative doesn’t remove any options for pain control. We do still prescribe opiates frequently for the control of pain in our emergency department. But I believe we are using these potent agents more precisely and more thoughtfully than ever before.

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