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Alternative To Opioids Bring ‘Revolutionary Change’ To Colorado Emergency Rooms

Stephanie Daniel
Charge nurse Kory Scheideman removes a dose of naloxone from Pyxis.

Charge nurse Kory Scheideman stood at a computer in an emergency room at UCHealth Medical Center of the Rockies in Loveland. He typed in his password, hit enter and Pyxis, the automated machine that dispenses medication, opened. He pulled out a dose of lidocaine.

“We use it for numbing people,” he said. “We also now use it for kidney stones.”

Kidney stones is a painful condition and in the past, an opioid like morphine or fentanyl would have been given for the pain. But today, emergency departments in Colorado are dispensing less addictive alternatives.

UCHealth Medical Center of the Rockies is one of 10 emergency departments that participated in the Colorado Opioid Safety Pilot. The six-month study measured how often emergency departments gave patients an alternative to opioids – also known as an ALTO.

“(The ALTO study) is one of the approaches that we, in emergency medicine, are trying to do our part to combat the national opiate crisis,” said. Dr. Eric Olsen, an emergency physician who works with Scheideman. “It’s out of control and the very sad piece of that is, it’s 100 percent created by the medical community.”

Credit Stephanie Daniel / KUNC
Dr. Eric Olsen gives a tour of a resuscitation room at UCHealth Medical Center of the Rockies in Loveland.

The study followed doctors, nurses and pharmacists at 10 urban and rural hospitals and freestanding emergency departments around the state. The goal was to replace pain management drugs like morphine and oxycodone with non-opioid alternatives – like acetaminophen, ketamine and lidocaine.

The study compared ALTO usage from June through November of last year to the same time in 2016. Researchers wanted to reduce opioid usage by 15 percent – but the results far exceeded that.

The results found a 36 percent reduction in opioid usage, a 31 percent increase in ALTO usage and 35,000 less opioids were dispensed. During the last two months of the study, doctors used alternative medications more than opioids.

Dr. Donald Stader is the associate medical director at Swedish Medical Center in Denver. The ALTO program originated in New Jersey but Stader was the first to bring it to Colorado. These opioid alternatives were so successful, the medications were added to the Colorado chapter of the American College of Emergency Physicians’ 2017 prescribing and treatment guidelines. From there, the group partnered with the Colorado Hospital Association and the study was born.

“You could see, at a certain point in October, ALTOs were used more than opioids, right? And that’s a revolutionary change. You can’t miss that point,” Stader said. “That’s a revolutionary change in how we’re practicing medicine.”

The 10 participating emergency departments included UCHealth locations in Loveland, Longmont, Greeley and Fort Collins. During the six-month study nearly 131,000 patients were treated across all locations.

The reduction in opioid usage at Medical Center of the Rockies mirrored the 36 percent state average – the highest reduction was 46 percent and the lowest, 31.

Olsen has been practicing medicine for about 25 years. He said it’s encouraging to see a change in opioid prescribing habits and he plans to continue using the ALTO protocols.

“It shows that we are in fact successful treating patients and addressing pain appropriately by using non-opioid methods,” he said. “It’s now a permanent part of my practice.”

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