Like every state in the nation, Wyoming had more than its fair share of opioid abuse. And, like every medical facility in the country, Cheyenne Regional Medical Center saw that abuse firsthand. In fact, in it’s efforts to treat pain, CRMC was partly responsible. They knew the only way t get ahead of the opioid issue was to start reducing opioids – and fast.
So they decided to ask not how much pain a patient was in, but how much could they tolerate.
The result, writes Casper Star Tribune’s Maya Shimizu Harris, was a watershed in reducing opioids. In fact, it “resulted in a 10% reduction in patients receiving opiates at the hospital’s emergency department” within the first six months. And with that, the Alternatives to Opioids program, or ALTO was born.
Those results have translated even more drastically to the Laramie County EMS ALTO program, which, Angela Vaughn tells Shimizu Harris, is one of the first EMS programs of its kind in the nation.
Vaughn should know, especially considering she’s CRMC’s community health project director. So it’s with good authority that we learn “more than 100 paramedics and emergency medical technicians with the Cheyenne Fire and Rescue and Cheyenne American Medical Response were trained through the ALTO program last year.”
It’s with just as good authority to find out that “the number of patients who were given opioids during an emergency response dropped about 28% in the program’s first year.”
Now that’s reducing opioids.
Reducing Opioids, The Wyoming Way
The ALTO program dates back to 2019 Vaughn asked Colorado emergency and addiction medicine physician Don Stader to bring it to CRMC.
“When you ask the right questions,” says Stader, “I think that what you discover is that many people are happy to tolerate pain and, in fact, would rather tolerate it than be exposed to something dangerous like a narcotic.”
Furthermore, “the program trains medical providers to understand pain psychology and conduct assessments to see if patients are tolerating their pain well.” In some cases “they might not need any medication at all.”
“I think there’s a much deeper story there than just, ‘Hey, we’re using alternative medicines,’” Stader said.
Indeed.
“Since the ALTO program’s beginnings, Stader and a team at his company, Stader Opioid Consultants, have expanded into the majority of Colorado’s emergency departments.” Since then “opioid use in the emergency department decreased more than 20%.”
Meanwhile, adds Shimizu Harris, “patient satisfaction scores showed ‘no significant difference’ when patients were asked how well their pain was controlled and how likely they would be to recommend the emergency department where they were getting care.”
The Colorado Hospital Association conducted a study of their own. And it found that the ALTO program had reduced the administration of opioids by an average of 36%.
Opioids in Wyoming
Wyoming is set to receive $52 million in settlement money from the federal lawsuit against opioid manufacturing giants like Purdue Pharma and Johnson & Johnson. In fact, some of which began making its way to the state last year.
But, writes Shimizu Harris, the state’s struggle with opioids is far from over. Between January and June 2022, opioid overdoses increased by 133% in Laramie County compared to the same time period the year before.
In January 2023 alone, Laramie County EMS responded to 32 overdose cases — the highest monthly number of the past five years,
Wyoming Department of Health claims the increase in overdose deaths is partly because of a flood of synthetic opioids, which caused more than four times as many fatalities this year.
It’s also clear that “opioid addiction often starts in medical settings,” which can easily “lead to using more dangerous drugs like heroin and fentanyl.” Granted, “opioid prescriptions fell by nearly 47% between 2012 and 2020.” Yet the CDC says “dispensing rates are still especially high in certain areas of the country.”
The ALTO program is designed to robustly address that issue.
Applauding Wyoming Stakeholders
Healing Properties applauds all the Wyoming stakeholders who’ve got behind the ALTO program. The more folks get to avoid encountering opioids, the less likely we’ll see opioid overdoses. In fact, it’ll have a positive impact all across the healthcare system.
We’re especially encouraged by the medical providers in Laramie County who have expanded their pharmacopeia to include alternative pain medications to opiates. Yes, that means Cheyenne Fire and Rescue, who in 2017 “started using ketamine in emergency response situations.” According to Shimizu Harris, Cheyenne Regional Medical Center “has since started using the medication, as well.”
Above all though, we’re grateful for Stader for bringing his ALTO program to Wyoming, as well as by his willingness to go above and beyond.
CRMC contracted Stader to provide the training, writes Shimizu Harris. But “because the hospital doesn’t have a steady stream of funding for training, he “made podcasts and videos so the hospital could use them when new people come on staff.”
The world could sure use a lot more like Stader.
If you’re having addiction issues, please give us a ring. And if by chance you find yourself being offered pain pills by some random ER, ask if they’ve got an alternative. Something, anything else but opioids will do you just as well. Just ask Wyoming.