NASHVILLE, Tenn. (WTVF) — Saint Thomas Health has been implementing changes for more than one year to help combat the opioid crisis, but like other efforts across the state, there are signs of unintended consequences.
Saint Thomas Midtown Hospital Chief of Emergency Medicine Dr. Ali Bollinger said amid changing prescription rules at all eight emergency departments, there has been an increase in patients admitted for heroin use.
"We've unfortunately seen a rise of heroin overdoses and users, so that's the next step is how we manage that," Dr. Bollinger told NewsChannel 5.
While she could not say the exact number of increases, the problem has been noticeable.
"In my last shift alone which is eight hours, I saw four overdoses," Bollinger explained.
The concerning trend comes as Saint Thomas Health significantly reduced the amount of opioid prescriptions for patients staying or leaving the emergency department by 66 percent.
The hospital's emergency department physicians have been choosing non-opiates first for treating most painful conditions to help patients with opioid use disorder or avoid drug diversion. They provide alternatives such as a combination of Tylenol and Ibuprofen, or using more Lydocain or Ketamine.
Bollinger said there is good data that shows they are as effective, if not better than some of the opioids that are being used.
The program that implemented the changes also had a nurse case manager whose job was to educate physicians and mid-level providers. They also worked with patients who frequented the emergency rooms more than once a week.
"We actually had our nurse case manager reach out to those specific patients to see if how they can manage their issues outside of the emergency department," Bollinger added.
Overall, the number of opioid deaths related to prescriptions started leveling out in Tennessee, although Tennessee is still one of the states with the highest prescription rate.
In 2017, Tennessee providers wrote 94.4 opioid prescriptions for every 100 persons. This was the third highest prescribing rate in the country and 1.5 times greater than the average U.S. rate of 58.7 prescriptions, according to the Centers for Disease Control.
Moving forward, Bollinger said the focus will be on creating an infrastructure to provide long-term care for patients who need help with their addiction. She is working the health department and other institutions to begin adding medically-assisted therapies and outpatient assistance for recovery.
"They need an alternative, we can't just say no, you're not getting it anymore," she said.