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Smithville, AR – The ongoing rise in demand for opiate medications, combined with limited supply of intravenous narcotics has left physicians, nurses, and pharmacists scrambling to address patients’ pain control at many institutions throughout the country.

Dr. Isaac B. Apusher, a local surgeon at Community General Hospital (CGH) in Smithville Arkansas speaks of his challenges: “I used to just write for Dilaudid PCA for every patient with a click of a button, but now alerts pop up telling me the pharmacy is out?! My patients are already rating their pain as 11 out of 10.”

Fortunately for Dr. I.B. Apusher and others at CGH, their proactive multidisciplinary pain management satisfaction team has developed strategies to address shortages.

Dr. B.Z. Meetings, the hospital president of the CGH network shares, “The first thing we’ve done is to implement a new code at our hospital. A ‘Code Magenta’ is announced overhead when supplies of opiates are running low, and not expected to last throughout the shift.” He goes on to say “We give carte blanche to our pharmacy team to do whatever it takes—no matter what—to make the pain go away.”

Concerns are heightened, especially with the upcoming visit by The Joint Commission. “Our JCAHO visit could happen any week. We just can’t have pain scores any higher than 4/10.”

With full administrative backing, Pharmacy has done some truly ‘out of the box’ thinking. The head of pharmacy at CGH, Robert Banks PharmD said the answer came to him when he saw a patient leave the ED against medical advice and was self-medicating in the parking deck.

“We realized some of our patients couldn’t get their opiates on the streets or from doctors and were turning to cheaper, more available, less regulated alternatives. I thought- we can totally do that.” The CGH pharmacy has contracted with an unnamed source to provide heroin to the pharmacy in times of opiate shortages. The substitution has been extremely well received by both patients, and hospital personnel. In addition, there are cost savings to be had.

According to Rob Banks PharmD “For a fraction of the cost of 100mg morphine, we can get almost half a kilogram of black tar heroin brought right to our back door.” In addition to filling the gap during shortages, heroin has proven quite useful for the patients who are ‘allergic to everything.’

The recent substitution has been correlated with a sharp rise in satisfaction scores, which CGH promptly advertised on billboards throughout the region. Interestingly, readmission rates have also sharply increased, and CGH is assembling a 25 person task force to conduct meetings in attempts to understand this unexplained rise in readmission rates.

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