UK’s chief medical officer says doctors should follow university trauma team’s example and not prescribe an opioid first

By Melissa Patrick
Kentucky Health News

The University of Kentucky hospital trauma team has adopted a protocol to treat acute pain that they hope will be adopted by the entire hospital: start with a non-narcotic first, and only prescribe a narcotic if the non-narcotic doesn’t relieve the patient’s pain.

“The protocol was developed with the trauma team and we are working with other disciplines within the hospital to see how we can widely adopt it as an institution,” UK trauma surgeon and Chief Medical Officer Dr. Phillip Chang told Kentucky Health News in an email. “In fact, we have established an ‘opioid stewardship committee’ within our hospital to continue to be responsible prescribers of narcotics.”

Chang told Miranda Combs of Lexington’s WKYT-TV that it is time for physicians to take it upon themselves to make similar changes.

He said giving patients a narcotic first for pain that should go away, like from surgery or trauma, isn’t the best way to care for them: “What we’re introducing to physicians is, let’s not think of narcotics as a mainstay; let’s think of everything else as the mainstay. That’s not to say ‘no narcotics;’ it is effective for the right patients.”

“Dr. Chang said 60 percent to 70 percent of those that become addicted get hooked from legal doctor prescriptions,” Combs reports.

Chang told Combs about a patient that came to the trauma center with severe pain from a car accident who was prescribed narcotics, but kept calling back for more painkillers because he said his pain wouldn’t go away. After investigating, Chang’s team discovered the patient had become addicted.

“We started getting suspicious because he needed to be off pain medicine by now,” he told WKYT. “He had accumulated multiple prescriptions, close to 1,000 pills when we added them all up in a four- to six-week time frame.”

Such cases prompted UK Healthcare‘s trauma team to adopt a new protocol about two years ago that requires its physicians to start with non-narcotics.

“We need to look at how we treat pain differently,” Chang said. “What happens is, you start with one drug, add a second, third, fourth, fifth, and then when you wean, you take the sixth, fifth, fourth and then you are left with the basic. If you start with narcotics, that’s the last one you get rid of. If you start with Tylenol, that’s the last you get rid of.”

Stateline reported in March that Kentucky has the nation’s fourth highest rate of painkiller prescriptions, at about 130 per year for every 100 people.

For the first time, in March, the federal Centers for Disease Control and Prevention offered guidelines for prescribing opioids. It said doctors should limit the length of opioid prescriptions to three to seven days, use the lowest possible effective dosage, monitor their patients closely and clearly tell them the risk of addiction.

Chang told Kentucky Health News, “We constantly review our outcomes and make adjustments to continue to improve the protocols for the benefits of our patients.”

Combs reports that a retrospective study, which has not yet been published, found that patients who came to the UK hospital with acute pain and usually didn’t take narcotics were able to go home with fewer narcotics, but those with acute pain who were already taking narcotics when they arrived didn’t have much change in the number of narcotics they went home with.

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