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Banding Together To Stop Opioid Addiction Where It Often Starts - In Hospitals

By Kaiser Health News  
   January 12, 2018

She said she was becoming like the patients with addiction problems that she transported by ambulance, lying to emergency room doctors to con a few extra doses.

Soon she lost her job and her fiancé, before going to rehab through American Addiction Centers and stitching her life back together.

A 180 On Opioids

Opioid addiction is a reality that has been completely disconnected from where it often starts — in a hospital. Anesthesiologist David Alfery said he was rarely stingy with the pain medicine.

"If I could awaken them without any pain whatsoever, I was the slickest guy on the block, and it was a matter of enormous pride," he said.

Alfery is part of a working group at the Nashville-based consulting firm Health Trust behind hospital efforts to set aside rivalry and swap ideas about a top priority: reducing opioid use.

"It starts with patient expectations, and I think, over the years, patients have come to expect more and more in terms of, ‘I don't want any pain after surgery,' and it's an unrealistic expectation," Alfery said.

Michelle Leavy had emergency gallbladder surgery in June. She refused opioids before, during and after the procedure. "It hurt," she says, "but I lived." (Courtesy of Michelle Leavy)

That expectation exists in part because pain treatment was institutionalized. Hospitals are graded on how well they keep someone's pain at bay. And doctors can feel institutional pressure, and on a personal level.

"I just wanted my patient not to be in pain, thinking I was doing the right thing for them and certainly not an outlier among my colleagues," said Mike Schlosser, chief medical officer for a division of HCA, the nation's largest private hospital chain.

Schlosser spent a decade as a spinal surgeon putting his patients at HCA's flagship facility in Nashville through some of the most painful procedures in medicine, like correcting back curvature. He said he genuinely wanted to soothe the hurt he caused.

"But now looking back on it, I was putting them at significant risk for developing an addiction to those medications," he said.

Using HCA's vast trove of data, he found that for orthopedic and back surgeries, the greatest risk isn't infection or some other complication — it's addiction.

So the nation's largest private hospital chain is rolling out a new protocol prior to surgery. It includes a conversation Schlosser basically never had when he was practicing medicine.

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


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