Doctors at Deaconess Hospital and St. Mary's Medical Center say they have long been following the spirit of new guidelines pushed by Gov. Mike Pence last week that urge emergency rooms to use caution when prescribing opioids for pain.
Pence, who formed a task force to address prescription opioid and heroin abuse last year, announced the new recommendations on June 21. Among other things, the task force encouraged doctors to exercise caution when prescribing opioids (especially for chronic pain situations), urged them to check a statewide monitoring program to see if the patient has a high number of previous prescriptions and reminded doctors that they have the right to drugscreen a patient before writing a prescription.
The suggestions were developed by the Indiana Hospital Association and the Indiana State Medical Association.
Emergency room doctors also can contact a patient's regular provider or request medical and prescription records before deciding whether to give a new prescription, according to the guidelines. They also urge emergency room personnel to keep a list of primary care providers or pain management specialists to give to patients, and pressed doctors to establish a policy that could help guide patients with suspected drug abuse problems into treatment.
Dr. Gina Huhnke, medical director of the emergency department of Deaconess Health System, said ER personnel at both Deaconess Hospital and the Gateway campus try to be "hyper vigilant" when it comes to identifying possible drug abuse cases. She said doctors regularly consult the monitoring system INSPECT, and noted that the emergency room does not replace opioid medication claimed to be lost or stolen - another issue raised by Pence's report.
"For years, we have used (our electronic medical record system) to alert health care providers of patients who might be at risk for opioid addiction and substance abuse," she said. "All patients who present to our facility undergo an appropriate medical screening examination and both our emergency departments follow guidelines to avoid excessive prescribing." The rush to use opioids to address both acute and chronic pain started about 25 years ago, said Dr. Timothy Almquist, assistant director of St. Mary's emergency department. Using them to treat chronic pain often leads to dependence and addiction to the powerful painkillers, a problem Almquist said St. Mary's has been trying "aggressively" to remedy for years.
"We have been very active in looking at this. We have a committee of clinicians who review these issues on a quarterly basis so that we are always aware, not only of the utilization from patients but aware from (the standpoint) of our providers and what their prescribing habits are," he said. " ... What has come out of the governor's office is something that we've been doing for seven or eight years." Opioid addictions can often be deadly. In 2015, prescription opioids contributed to at least 31 of the 47 overdose deaths in Vanderburgh County, according to the coroner's office. Some addicts who can no longer get pills to fulfill their opiate habit turn to heroin because it can be easier to get. It's also cheaper than prescription painkillers.
Even if emergency rooms have already implemented most of the suggestions put forth, "it is recommended that hospitals review their currents practices on use and prescribing opioids and other controlled substances in the (emergency department) and, if necessary, take action to align current policies with the recommended guidelines," state officials wrote.
While the guidelines won't have much of an effect at either of Evansville's major hospitals, both Almquist and Huhnke said the task force work is good when it comes to helping stop abuse.
"I applaud Gov. Pence for bringing attention to this opioid addiction epidemic. As we witnessed in Southeastern Indiana this has become a big problem in our state and across the nation. Patients with addiction problems frequently visit multiple locations to try avoid detection," said Huhnke, referring to the 2015 HIV outbreak in Scott County that largely affected users of the powerful opiate-based painkiller, Opana.
Almquist said those who get opioids for acute pain should not be worried about getting hooked on the drugs right away, but he urged them to be cautious with such prescriptions. Huhnke added that as long as patients take them "exactly as your doctor directs," there is "very little risk" of developing a dependency from a single prescription.
"There is a place for opiate prescriptions, and generally it's for a very short period of time. Three days, five days, maybe a week," Almquist said. "But beyond a week, the use of opiates should really be done under the very strict control of your primary care doctor or pain management specialist."