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Some hospitals are admitting they have prescribed too many opioids. Their goal was to keep patients as pain-free as possible before, during and after surgery. Now in an effort to be part of the solution to the country's opioid crisis, a few of the largest hospital chains are issuing an uncomfortable warning to patients. You're going to feel some pain. Blake Farmer of member station WPLN in Nashville reports.
BLAKE FARMER, BYLINE: Michelle Leavy welcomed the high-dose IV narcotics while she was in the hospital for a C-section.
MICHELLE LEAVY: I had the C-section, had the kiddo. And then they told me, you know, it's OK. You can keep taking the pain medications. It's fine.
FARMER: The Las Vegas mother of three is a paramedic who's dealt with many addicts herself, but she gladly followed doctor's orders and kept ahead of the surgical pain with her Percocet pills. But then she needed stronger doses until she was no longer treating pain.
LEAVY: And then I was taking them just to go to bed. I really didn't realize I had a problem until the problem was something more than I could have taken care of myself.
FARMER: She was becoming like the addicts she transported by ambulance, lying to ER doctors to con a few extra doses. Pretty soon she lost her job and her fiance before going to rehab and stitching her life back together. It's a reality that's been completely disconnected from where it often starts - in a hospital. Anesthesiologist David Alfery in Nashville says he was rarely stingy with opioids.
DAVID ALFERY: If I can waken them without any pain whatsoever, I was the slickest guy on the block. And it was a matter of enormous pride.
FARMER: Alfery's part of a working group at the Nashville-based consulting firm Health Trust, where hospitals have set aside some of their competitive interests to swap ideas on a top priority - reducing opioid use.
ALFERY: Over the years, patients have come to expect more and more in terms of, I don't want any pain after surgery. And it's an unrealistic expectation.
FARMER: Hospitals have been graded on how well they keep someone's pain at bay. And doctors can feel some pressure on that institutional level as well as a personal one, says Mike Schlosser, a former spinal surgeon.
MIKE SCHLOSSER: I just wanted my patient not to be in pain, thinking I was doing the right thing for them and certainly, you know, was not an outlier amongst my colleagues.
FARMER: Spine surgeries like correcting back curvature can be especially painful. He says he wanted to soothe the hurt he caused.
SCHLOSSER: Looking back on it, I was putting them at significant risk for developing an addiction to those medications.
FARMER: Schlosser is now a top medical officer for the country's largest private hospital chain. At HCA, he's found that for orthopedic and back surgeries, the greatest risk isn't infection or some other complication. It's addiction. So HCA is rolling out a new protocol. It includes a pre-op conversation Schlosser rarely had himself.
SCHLOSSER: We will treat the pain, but you should expect that you're going to have some pain. And you should also understand that taking a narcotic so that you have no pain really puts you at risk of becoming addicted to that narcotic.
FARMER: In addition to the uncomfortable warning, sparing use of opioids also takes more work, trying nerve blocks and finding the most effective blend of non-narcotics to treat pain. And everyone in the hospital has to stick to it. John Young, a medical director for LifePoint Hospitals, says businesswise, no one wants to be known as the place where it hurts more.
JOHN YOUNG: You don't want to portray the fact that you're not going to treat people appropriately.
FARMER: But he says it's critical that hospitals tighten up on opioids.
YOUNG: We really do have a lot of responsibility and culpability and this burden. So we do have to make sure that we do whatever we can to turn the ship in the other direction.
FARMER: After going to rehab following her C-section, Michelle Leavy had gallbladder surgery last year without any narcotics before, during or after.
LEAVY: I mean, it hurt, but I lived.
FARMER: Leavy says she was nervous about telling her doctors, but they were happy to find opioid alternatives. For NPR News, I'm Blake Farmer in Nashville.
MCEVERS: This story is part of a reporting partnership with NPR, Nashville Public Radio and Kaiser Health News.