“I had the C-section, had the kiddo,” said Michelle Leavy of Las Vegas. “And then they tell me, ‘It’s OK, you can keep taking the pain medications, it’s fine.'”
Leavy is a mother of three and a paramedic who has dealt with many patients coping with addiction. She welcomed the high-dose intravenous narcotics while in the hospital and, upon her release, gladly followed doctors’ orders to keep ahead of the pain with Percocet pills.
But then she needed stronger doses. Soon, she realized, she was no longer treating pain.
“Before I went to work, I took them, and to get the kids after school, I had to take them,” she said. “Then I was taking them just to go to bed. I didn’t really realize I had a problem until the problem was something more than I could have taken care of myself.”
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.
A 180 on Opioids
Opioid addiction is a reality that can be disconnected from where it sometimes start—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.
“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 of 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.
“We will treat the pain, but you should expect that you’re going to have some pain. And you should also understand that taking a narcotic [dose so high] that you have no pain, really puts you at risk of becoming addicted to that narcotic,” Schlosser said, recounting the new recommended script for surgeons speaking to their patients.
Besides issuing the uncomfortable warning, sparing use of opioids also takes more work on the hospital’s part—trying nerve blocks and finding the most effective blend of non-narcotic medicine. Then after surgery, the nursing staff has to stick to it. If someone can get up and walk and cough without doubling over, maybe they don’t need potentially addictive drugs, or at least not in high dosage, he said.
There are potential benefits aside from avoiding addiction.
Managing the Optics
Of course, business-wise, no one wants to be known as the hospital where treatment hurts more.Young said tightening up on opioids becomes a delicate matter but it’s the right thing to do.
“We really do have a lot of responsibility and culpability in this burden, and so we have to make sure we do whatever we can to stem this tide and turn the ship in the other direction,” he said.
While hospitals get their ship in order, some patients are taking personal responsibility.
Now that she’s in recovery, Michelle Leavy won’t touch opioids. That meant she had emergency gallbladder surgery in 2017 without any narcotics. Leavy said she was nervous about telling her doctors about her addiction, but they were happy to find opioid alternatives.
“I mean, it hurt,” she said. “But I lived.”
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