Todd Allen is the medical director of the emergency department at Intermountain Healthcare. Last month, he announced that Intermountain would reduce prescription levels of opioid painkillers by 40 percent by the end of 2018. Allen recently spoke with KUER about how they plan to do that.
Below are excerpts of the conversation.
Allen: Part of the reason we're here today, part of the reason we over-prescribe is that as caregivers, as physicians and nurses, it's built into our DNA to help people out of suffering and particularly pain. We tried for decades to minimize pain and almost make pain zero. What it meant is we over-treated and treated incorrectly with some biases to conditions that don't need medications like opioids.
Q: Is this an admission that Intermountain and other hospitals are over-prescribing opioids by 40 percent?
Allen: Yup, happy to own it. I wouldn't say we're over-prescribing by 40 percent. We set the goal based on a number of factors. We don't know what we're over-prescribing by because we've never asked that question. We've never studied that question in a formal way. If you look out in the literature it's hard to say. For, let's say, a long bone fracture, what's the right amount of opioids? Strength and number? That study has not been done. So, we think we're over-prescribing by about 40 to 50 percent based on the limited studies that we've done internally to try to figure out what the goal is.
Q: There are lots of different cases when people might be prescribed opioids. How do you do this in a nuanced way so that people are not under-prescribed when they really need opioids?
Allen: Long bone fractures, kidney stones, painful sickle cell crisis - brutal. I've suffered from a few of those. Wouldn't want to suffer from any of them. In those cases and in cases of chronic pain like patients with cancer, we want to stick right where we've been - help patients avoid as much suffering as possible. In other cases like headache or back pain, opioids have been shown to be harmful, to decrease the effective outcomes. There we just have to get out of the pattern, the habit of reflexively writing these prescriptions and for so many tablets, and think of something else - other alternatives to help control pain in those cases.
Q: Can you be specific in what some of those therapies are?
Allen: Just for pain control, Tylenol, acetaminophen, Ibuprofen would be the starting point. Other things that we've got that we haven't used very well. I would include massage. I would include acupuncture. As physicians particularly from the allopathic and the Western tradition, I don't know that we've been very good at using those adjuncts. We've instead relied on chemicals.
Q: How do you make sure that there's not unintended consequences of people moving to street drugs like heroin if they get fewer prescription drugs?
Allen: By reducing the number of tablets that we put out there we don't want it to make people be forced to turn to street drugs or be forced to other difficult or sometimes illegal methods. That's why we just didn't come out of the blue and say we're gonna drop things by 40 percent. We've been working for two-and-a-half years to build up a comprehensive plan with the state, with the Department of Health, with healthcare organizations, and health organizations from different counties to be thoughtful and comprehensive about that. There is no one magic bullet that's gonna cure this thing. We've spent two decades building this up. It's gonna take a while to dig out and it's gonna take a full effort.