Experts explain how to end opioid overdose epidemic

AMA Wire
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The nation has seen a four-fold increase in opioid deaths in the last decade, according to the Centers for Disease Control and Prevention (CDC)—and physicians stand on the front lines of this national health crisis. During the 2015 AMA Interim Meeting, physician experts recently discussed actions you can take now to help combat the opioid epidemic and improve patient care.

Rethinking prescribing practices, effectively using PDMPs

CDC Director Thomas Frieden, MD, was among a panel of experts who offered actionable solutions to help curb the nation’s high rate of opioid overdoses. He noted that the rise in opioid-related deaths and abuse directly correlates with an increase in the prescribing of opioids.

Unless physicians adopt improved practices for prescribing for pain, he said the nation will continue to struggle with addiction. That’s why he recommends that every physician should view prescribing an opiate as a “momentous decision,” in which they should carefully assess whether the opioid is an essential form of treatment.

One way physicians can better assess whether to prescribe an opioid is to effectively use prescription drug monitoring programs (PDMPs), said Sharon Meieran, MD, a lead physician from the Emergency Department for Emergency Psychiatric Services at Kaiser Sunnyside Medical Center in Oregon.

“Different specialties have their unique challenges, but we all share the common goal of wanting to take care of our patients and wanting to keep them safe, so we very much need the information that can be provided by the PDMP—and really at this point only the PDMP,” Dr. Meieran said.

She said using Oregon’s PDMP has effectively helped her monitor trends in opioid prescriptions and find important patient information—or spot any potential red flags in a patients’ history—before prescribing an opioid.

Dr. Meieran encouraged physicians to register for their state prescription drug monitoring programs and use them to help inform the risk-benefit analysis when considering to prescribe opioids for patients.

Reducing stigma to improve patient care

In addition to carefully monitoring opioid prescriptions, American Academy of Pain Medicine President-Elect Daniel Carr, MD, also stressed the importance of reducing stigma and bias against patients who may genuinely require opioid medications or other treatment for chronic pain.

Dr. Carr was the founding editor of Pain: Clinical Updates and noted that the journal already has received “84 citations on stigma alone in the last few years,” which underscores that stigma—often the result of wrongfully judging patients or harboring bias against them—is a deeply entrenched problem in health care that needs to be addressed.

“There is a huge [amount of] literature on stigma and pain,” he said, referencing a recent article that discussed stigma among sufferers of lower back pain. “Stigma is consistently experienced by such patients and propagated by health care professionals … the ramifications of stigma and discrimination are enduring, potentially disabling and interfere with care-seeking or rehabilitation participation and success.”

Dr. Carr reminded physicians that chronic pain is a public health issue He also encouraged physicians to educate themselves about stigma in pain medicine and unconscious bias to help advance patient care.

Richard Soper, MD, chief medical officer and director of addiction medicine at the Center for Behavioral Wellness in Nashville, Tenn., agreed with Dr. Carr that reducing stigma is key to improving care, especially among patients struggling with substance abuse and mental illness.

“The antidote for the toxic presence of stigma is proper medical treatment,” he said, noting that physicians must alter how they discuss addiction, mental health and treatment.

“We need some shifting in conversation and the verbiage amongst ourselves and the general public,” he said.

How physicians can advance opioid education and prescribing practices

Patrice A. Harris, MD (pictured above), chair-elect of the AMA Board of Trustees, who chairs the AMA Task Force to Reduce Prescription Opioid Abuse encouraged physicians also to study the best practices for prescribing opioids, managing pain and treating substance use disorder.

The task force offers a collection of the best educational resources from more than 70 organizations, including state medical associations and medical specialty societies.

“Challenge yourself and your colleagues to ensure they have the latest information about safe, effective prescribing,” Dr. Harris said.

She also urged physicians to adopt prescribing and co-prescribing the opioid overdose reversal drug naloxone to patients who are at risk. Dr. Harris noted, “It’s up to us to be the leaders our nation and our patients need to bring an end to this public health crisis.”

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This problem was NOTHING like it is now, until they started releasing super-addictive opioids such as Oxycontin, et al. West Virginia - example: state with little hope of gainful employment, abject poverty, yet extremely low crime rate - Until oxycodones came into the market there. Experts will give you all kinds of smart sounding, authoritative reasons why we "need" oxycontins. We don't. We got along fine with morphine, Vicodin and so on.
Pardon my observations of the last 38 years: Medical Schools & All Clinical Care Residencies have emphasized teaching of Science, Technology, and Informatics as the "gospel of today's Physicians and Surgeons practices", therefore, hunger pangs are equal to fracture pains; Rx fad of HydroC or OxyC for "treatment" is issued with minimal or no detailed evaluation of the patient<br/> <br/> My believe and daily practice say "doctor or Teacher of med/surg", treat the patient using the TEACHINGS of "ars medica". It applies professional knowledge-acquisition of Culture, Habitus, Human Behavior, Observation of Pain Threshold, Malingering, Pathology, Psycho-Social Hx, Science, Technology, Informatics, Outcome Assessment Algorithm, and etc. Such evaluation could be accomplished with an intuitive understanding of the patient's detailed Hx.<br/> <br/> If "doctoring or Teaching a patient about their health and wellness" is one side of a 2-sided coin of "ars medica", then "physique or Examination of a patient for pathology that needs treatment" is the other side of the coin. A Physician and Surgeon MUST JUSTIFY to the patient, peers, students, residents, insurance, ethicist, family, and etc the REASONS why HydroC and OxyC is an appropriate Rx for that patient. Furthermore, the patient must be doctored, on adverse events of all medicines; informed of NSAIDS or Alternative Remedies, with clear-cut education on the findings from the patient's "physique" evaluation.
I don't deny that people abuse prescription drugs, but because I live in Tn. I cant get the help I need. I have 2 collapsed hips and have been in excruciating pain for 3 years. i also have a buldging disc and bone spurs. I definitely have chronic pain, but as of now no help from doctors. I guess they would rather see me overdose on over the counter pain meds than prescribe anything for pain. <br/> I feel sorry for this country where people that really need help cant get it because doctors are too afraid to help.
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