HAMPTON, Va. (WAVY) — Doctors at Sentara CarePlex say they no longer reach for opioids as the first line of defense against pain. They’re using other medicines to treat common conditions.

Even as head of the emergency department, Dr. Josh Smith of Envision Physician Services can’t remove any of the morphine, Percocet and other opioids stored in the hospital’s secured area. He needs an ER nurse to make that happen as part of the security that surrounds the hospital’s opioid supply.

“One of our defaults was to go straight for narcotic pain medication, and I think we were using it probably too much,” Smith said, regarding how doctors treated pain in the past.

He says patients have changed their thinking, too.

“I have patients that come in now that start the conversation with ‘I don’t want anything narcotic, what other options do you have?’”

Smith says the CarePlex ER reduced its opioid prescriptions 70% in just one year by opting for other treatments.

“For things like migraines there are things like anti-inflammatories that are effective … for back pain there are different anti-inflammatories and muscle relaxers, and different topical pain medications that might be effective.”

Smith also says lidocaine through IV is effective for kidney stones, and nerve blocks for broken bones. But for some patients, Smith says opioids remain the right choice, including those with cancer or a sickle cell crisis for example.

Sentara spokesman Dale Gauding says system wide, its Optima health plan has been able to cut opioid prescribing for Medicaid members by 49 percent.

“I think we can look at our entire system and see a marked reduction in opioid prescribing and in opioid use,” Gauding said.

Sentara has also cut its use of opioids surrounding surgery.

Sentara says doctors at CarePlex work with Hampton Police in supplying and training them in the use of naloxone – the overdose reversal drug. Naloxone has enabled police to save lives even before an ambulance can get someone to the hospital.