The “Improving Emergency Department Management of Acute and Chronic Pain Using Non-Opioid Strategies” project will lead the way to better pain management in Arkansas by training University of Arkansas for Medical Sciences (UAMS) emergency department (ED) physicians and nurses on opioid-sparing pain management strategies. Some quick stats about Arkansas and the UAMS ED:
• Arkansas is predominantly rural, with the 6th highest poverty rate in the nation
• The state is in the top 10% of states for persons needing opioid use disorder (OUD) treatment, but has poor access to treatment providers and facilities
• UAMS is the state’s only academic medical center, has the largest residency training program in emergency medicine, and serves >65,000 patients per year
• An average 11,000 patients per year present to the UAMS ED for pain, with nearly ¼ given opioids in the ED
• If discharged with opioids, patients receive a mean prescription duration of 36 days but <1% receive take-home naloxone at the same time
We believe that training providers on alternatives to opioids will not only help current UAMS patients, but will also help the rest of the state for years to come. This is because approximately 45% of EM residents remain in Arkansas after graduation, and the majority of ED physicians currently working in Arkansas were trained at UAMS. We are also hopeful that the UAMS ED can also serve as a statewide model for successful pain management without opioids, since Arkansas has had the second-highest opioid prescribing rate in the nation since the early 2010s. In 2016, Arkansan physicians prescribed 114.6 opioid prescriptions for 100 people. While this declined to 75.8 per 100 persons by 2020, this rate is still 75% higher than the national average of 43.3 prescriptions per 100 persons.
This project proposes three large initiatives to reduce opioids in the ED:
• Education on opioid-sparing pain management, including didactic education, clinical decision support in the electronic medical record, and Academic Detailing (AD)
• Peer Navigators, in a slightly expanded role to increase patient knowledge about how to manage pain without opioids, opioid hazards, and take-home naloxone
• Implementation of interventional pain procedures like acupuncture and nerve blocks to treat pain in patients for whom opioids are either ineffective or hazardous
The impact of these initiatives will be profound, as we estimate that we will be able to affect care for more than 8000 patients per year who present for painful conditions. In addition, once the program is successful, we hope to use our program as a model of aggressive pain management without opioids throughout the State of Arkansas.