Healthcare News and Trends
10 Ways Physicians Can Help Curb the Opioid Crisis
October 08, 2018
By Debra Wood, contributor
More than 115 people die each day in the
United States from an opioid overdose, an issue the federal government calls an
opioid crisis. Multiple factors have contributed — everything from prescribing
at greater rates to patient diversion and misuse.
“This is a complex problem with complex
origins,” said Edward Michna, MD, an American Pain Society board member and anesthesiologist
and pain specialist at Brigham and Women's Hospital in Boston.
D. McGee, MD, chief medical officer at The Haven at Pismo in Avila Beach,
California, called the opioid epidemic a “wicked problem,” which has a formal
definition of multiple contributing factors that cannot be solved easily.
“The solution will have to be through
multiple, different dimensions over a sustained period of time to address the
problem,” McGee said.
The National Institute on Drug Abuse reports
from 21 percent to 29 percent of people prescribed opioids misuse them and from
8 percent to 12 percent develop an opioid use disorder.
“Physicians need to be aware of the risk, and
let patients know it could damage their life,” McGee added. “That gives us
pause before prescribing opioids. There are equally good ways to manage pain
positive trend toward fewer opioid prescriptions
The number of opioid prescriptions being
written has declined 22.2 percent from 2013 to 2017, according to the American
Medical Association (AMA), with a 9 percent drop occurring from 2016 to 2017. Providers
wrote 196 million opioid prescriptions in 2017, down from 251.8 million in 2013.
Survey of America’s Physicians, conducted by Merritt
Hawkins on behalf of The Physician’s Foundation, confirmed this trend; 69
percent of the physicians surveyed reported writing fewer prescriptions for
pain medications in light of the opioid crisis.
Physicians, nurse practitioners and others
with prescriptive authority must take a proactive stance in order to keep this
trend headed in the right direction, while addressing other factors that have
led to the country’s current crisis.
ways clinicians can play a role in curbing the opioid epidemic
Follow the guidelines for chronic pain
The Centers for Disease Control and
Prevention (CDC) reports that in 2016, 50 million U.S. adults, or 20.4 percent,
suffered from chronic pain; 19.6 million, or 8 percent, had high-impact chronic
pain, defined as pain that limits life or work activities.
The CDC issued guidelines for managing
chronic pain, which call for nonpharmaceutical treatments and non-opioid
pharmaceuticals before considering an opioid.
Other professional and accreditation organizations
also have issued guidelines, including the American Academy of Pain Medicine,
the Departments of Veterans Affairs and Defense, and The Joint Commission,
which suggests behavioral approaches, environmental interventions, physical
interventions, and non-opioid pharmaceuticals.
“Individualize care, look at the situation
and utilize all of the potential non-opioid therapies to try to help with
improving the pain,” Michna said. “Alternative therapies should always be part
of the therapy, whether opioids are involved or not.”
Evaluate and monitor patients thoroughly
“The whole thing starts with appropriate
evaluation of the patient and monitoring the patient, and for acute problems
getting the patient off [opioids],” Michna said. “There are varying tools you
can use. Look at the history. Talk to the patient. Ask the questions.”
Check the databases
Use the prescription drug-monitoring program
in your state. More than 1.5 million physicians and other prescribers have
registered for the programs nationwide and they made more than 300.4 million
queries in 2017, representing a 121 percent increase from 2016.
Increase access to naloxone
The AMA, the American Academy of Family
Physicians (AAFP), and other professional groups recommend increasing access to
naloxone, which can be used to reverse the effects of opioids.
Enhance your education
The AMA also urges physicians to learn more
about opioid prescribing, pain management, and screening for substance use
“Physicians need to become much more expert
in pain management,” McGee said. “They need to know about multimodal,
nonnarcotic ways of managing pain.” Those things, he said, include
pain-modulating strategies to increase the pain threshold, relaxation,
mindfulness, acceptance, positive thinking and other strategies.
McGee recommends licensing boards require
education in pain management for relicensure.
Refer patients to pain management experts
Some patients will benefit from a referral to
a pain management practice, which offers a multimodal approach to treatment,
including behavioral therapy and teaching patients to learn to live with it,
“There is a social or cultural aspect to
this,” McGee said. “We live in a discomfort-phobic society.”
McGee suggested collaborating with experts in
the psychological management of pain and helping patients shift from distress
intolerance to making the best of life, even with pain.
“Acceptance is huge,” he said. “Learning to
live with it. If we did that, think how much happier we would be as a culture.”
Support greater access to treatment
More physicians are being certified to
provide buprenorphine treatment, 50,000 currently. The AMA encourages payers to
cover medication-assisted treatment.
A study from researchers at Virginia
Commonwealth University in Richmond, Virginia, found that early-care family
physicians do not feel they are properly trained to provide buprenorphine
treatment for opioid use disorder.
The U.S. Senate’s Opioid Crisis Response Act of 2018 (S.2680)
would allow states to receive Medicaid matching funds from the federal
government for services associated with opioid or cocaine use disorders.
Support coverage for non-opioid pain care
While multiple studies show that acupuncture,
physical therapy and other integrative therapies can relieve pain, many health
insurers do not cover these treatments. The AMA encourages payers to change
policies to increase access to these treatments.
“If insurance does not pay, you can recommend
[nonpharmacuetical therapies] all you want, but it’s not going to happen,” Michna
said. “Insurance companies incentivize opioids.”
McGee added, “If we really wanted to address
this epidemic, we would have a national initiative to get insurers to cover
complementary and alternative treatments for pain.”
Stay abreast of new medications and rules
Many researchers are working to develop new
types of pain medications. The recently passed Senate bill—lauded as a
significant legislative achievement and “a rare bipartisan response to a public
health crisis” by The
Washington Post—aims to fast-track new, nonaddictive analgesics.
The Centers for Medicare & Medicaid
Services plans on limiting first-time opioid prescriptions to a 7-day supply for
patients with acute pain. Additionally, the U.S. Food and Drug Administration approved
the final Opioid Analgesic Risk Evaluation and Mitigation Strategy, expanding
it to include immediate release opioids in the outpatient setting.
Help change perceptions and the stigma
The AMA states, “Patients with pain or
substance use disorders deserve the same care and compassion as any other
patient with a chronic medical condition.”
“We must all confront the intangible and often
devastating effects of stigma,” explained Patrice A. Harris, MD, AMA
president-elect and chair of the AMA Opioid Task Force, in a recent article
for AMA Wire. “The key to recovery is support and
compassion. Patients in pain and patients with a substance-use disorder need
comprehensive treatment, not judgment.”
Initiative (Helping End Addiction Long-term) - NIH
the Opioid Epidemic - AMA
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