LITTLE ROCK, Ark. — Arkansas has the second-highest opioid prescribing rate in the nation. According to the CDC, it has been that way since 2010, but the University of Arkansas for Medical Sciences is aiming to put an end to overprescribing opioids in the state through a new grant announced this week.
The National Substance Abuse and Mental Health Services Administration has given UAMS’s Department of Emergency Medicine $1.5 million which will be put to use educating new physicians on how to use interventional pain procedures like nerve blocks and acupuncture. The treatment options will come into their emergency department. UAMS will also be adding pain peers who have gone through the journey already to help a patient during or after treatment.
A hospital is a place you go to for recovery, but for Bart Caulder what came prescribed from a doctor’s prescription sent him in the opposite direction.
“Somebody gave me a pill one day. A hydrocodone, and I took it, and I liked the way it made me feel, and I began to pursue that,” Caulder said.
Before finding the Little Rock Compassion Center and going through its drug and alcohol program, opioids led Caulder and his family to homelessness.
“They’re extremely hard to get off, and you are miserable, a miserable person physically, mentally because of the withdrawals,” Caulder remembered.
One pill became 25 a day. Caulder bought from a dealer who bought them from people’s cabinets, those who had an overabundance or weren’t taking them anymore.
Dr. Michael Wilson is an associate professor in the UAMS College of Medicine departments of Emergency Medicine and Psychiatry. He admitted, “Arkansas has a prescription opioid problem.”
“The medical profession ourselves are also to blame. We were told, I was taught when I was in medical school that if someone had ‘true pain’ that giving them opioids would never harm them, and in fact not giving them opioids would harm them because they’d have to live with the untreated pain for a number of years,” Dr. Wilson said. “We know that this isn’t true. We know now in 2023 that we can treat people’s pain, and we can treat it without opioids in several different years.”
For the next three years, a project at UAMS’s Emergency Department called “Improving Emergency Department Management of Acute and Chronic Pain Using Non-Opioid Strategies” will improve pain relief while reducing the use of opioids through three initiatives.
The first and largest component is education, teaching new physicians interventional pain procedures like nerve blocks and acupuncture. Second, UAMS’s emergency department will be equipped to provide those treatment options. Third, the emergency department will be adding support through peers who have gone through the journey already to help a patient during or after treatment to manage their own pain.
Dr. Wilson stated emerging data is showing that those who take opioids over time can sometimes make their pain worse.
Wilson is the co-primary investigator with Carly Eastin, M.D., an associate professor in the UAMS Departments of Emergency Medicine and Pediatrics, who added, “This is because approximately 45% of UAMS emergency medicine residents remain in Arkansas after graduation, and the majority of emergency department physicians currently working in Arkansas were trained at UAMS.”
“If we can teach them (new physicians) how to do this correctly now, we will literally change practice in Arkansas for the next 30 years or until these folks retire,” Dr. Wilson added.
UAMS is Arkansas’ only academic medical center and states it has the largest residency training program in emergency medicine, which serves more than 65,000 patients annually. UAMS said on average, 11,000 patients each year come to its emergency department complaining of pain. Wilson said pain is the number one reason people seek help there.
“We estimate that we will be able to affect care for more than 8,000 patients each year who come to the emergency department with painful conditions. We hope the program will become a statewide model for aggressive pain management without opioids,” Dr. Wilson said.
Caulder hopes the grant will help those who never want to take the drug have to do it again.
“There is a big need for that, yeah, because they are addicting. It is addicting. It is an addicting drug. It almost took me out. It almost killed me,” Caulder admitted.
According to CDC data in 2016, Arkansas physicians prescribed 115 opioid prescriptions for every 100 people, so more pills than the people living in the state. While the number declined to about 75 for every 100 people by 2020, The national average is a little over 40 prescriptions per hundred people.