As the opioid epidemic continues, hospitals are looking for new ways to treat pain and combat addiction. At Indiana University Health, which has 16 hospitals across the state, that means change. They鈥檙e cutting back on opioid prescriptions and giving more advice to patients.
In January 2017, IU Health officials began monitoring when, where, and by whom every opioid was prescribed.
Chief Medical Officer Jonathan Gottlieb says the results were eye opening for his fellow doctors. 鈥淵ou know, I think no one really knows when they鈥檙e operating independently, am I in the middle of the bell curve, am I at one end or the another? Just showing the data caused a dramatic reduction in the number of pills prescribed.鈥�
Comparing the first month of monitoring to one of the most recent, this April, nearly 440,000 fewer opioid pills were prescribed.
And that鈥檚 important because many people feed an addiction by getting pills from friends and relatives.
IU surgeon Amy Krambeck cut back opioid prescriptions for other reasons. She specializes in removing kidney stones.
鈥淪o we use a small scope and go up into the ureter, break up a stone and pull out the pieces,鈥� she says. 鈥淪o it can be a fairly painful procedure 鈥� especially with the stent left in afterwards.鈥�
Krambeck says opioids are the standard pain medication after the procedure. But she found while lecturing in Mexico that鈥檚 not true everywhere.
She recalls, 鈥淚 came back after one of those trips and said, 鈥業 just want to stop giving narcotics to our patients and start using anti-inflammatories, smooth muscle relaxants 鈥� other ways to manage the cause of the pain.鈥欌��
Krambeck says her team worried that post-op patients would call for more medication 鈥� but that didn鈥檛 happen. And in the first year, it kept 4,600 opioid tablets from going home with patients 鈥� possibly ending up in the wrong hands.
Gottlieb says another success is the 30 percent drop in opioid prescriptions at IU Health emergency departments. The biggest drop 鈥� 90 percent 鈥� came in Frankfort.
Phone alerts indicate a patient is waiting for one of IU Health鈥檚 peer recovery coaches. The new program helps people who are addicted to opioids and come to an emergency department for more pills.
They鈥檒l meet someone like Spencer Medcalf, and get an unusual welcome: 鈥淚鈥檓 a peer recovery coach but more importantly I鈥檓 a person in long-term recovery from a heroin addiction. What brought you to the ED today? What鈥檚 going on with ya?鈥�
He鈥檚 one of seven coaches working at a 24/7 hub in Indianapolis. Through video chats, they help patients get treatment across the state. Medcalf鈥檚 own experience helps 鈥� he got clean when his family cut him off.
鈥淪o when I hear patients in the ED talk about those things 鈥� where my family is concerned or my wife or husband is really concerned 鈥� and they鈥檙e talking about divorce or leaving. That鈥檚 kind of an internal red flag,鈥� he says.
Cutting back on opioids in post-op and emergency departments is a start.
Gottlieb says it鈥檚 more challenging when it comes to patients with chronic pain. 鈥淥ne of the things that we and others are doing is offering alternatives that are not only to reduce the risk from opioids, but also to offer more effective pain therapy.鈥�
His dream is to have IU Health provide wraparound care with specialists in fields like rehab, neurology and psychiatry.
Pain researcher Dr. Kurt Kroenke of the Regenstrief Institute in Indianapolis, says doctors still feel a lot of pressure 鈥� especially treating chronic pain.
鈥淢ost physicians are feeling they鈥檙e being heavily watched, whether it鈥檚 by the D-E-A, or you know, state regulations or their healthcare systems,鈥� he says 鈥淵ou鈥檙e a good citizen the less opiates you prescribe. And if you prescribe beyond that 鈥� you鈥檙e being scrutinized.鈥�
He says it鈥檚 a tightrope for providers: control pain, don鈥檛 under prescribe causing harm, and don鈥檛 play a role in new addictions.
Meanwhile, Krambeck is trying to convince reluctant colleagues to reduce opioid prescriptions.
鈥淛ust getting it out there and getting it on the table for them to hear, I think sparks the wheels turning,鈥� she says. 鈥淎nd I could tell they were considering how that would affect their practice. And that鈥檚 the first step, is to just start thinking about it.鈥�
The change isn鈥檛 over for IU Health. Hospital leaders say it will take a couple more decades to address all areas of the opioid crisis.
This story was produced by, a new collaborative covering public health.
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