With all of the recent attention cast on the national opioid epidemic and the increase in overdose deaths, one issue that seems to have fallen out of focus is the need for increased scrutiny on concomitant drug prescriptions, particularly benzodiazepines. The combination of opioids and benzodiazepines was found to be dangerous enough that dual prescribing of the two medications caused the FDA to issue black box warnings when prescribing each of these medications in 2016. An article originally published in Clinical Advisor (March 2017) makes two important points:
At AffirmHealth, we're passionate about improving the processes needed to manage chronic pain safely. In the past, I've written several times about the patient-physician relationship and the complex parts of managing those relationships in the setting of our national opioid epidemic. This morning, CNN published an interesting article that highlights another side of the problem: the increasing legal issues that physicians are facing as they navigate the pain management landscape. I share it here not so much to give a direct opinion on the issue, but because I feel that it's important that we all engage in a discussion informed by everyone's viewpoint. This article goes a long way to sharing the evolving physician and law enforcement perspective. The following is directly reprinted from CNN:
A few days ago, Mark Jarrett penned a provocative online op-ed on The Hill website, “Congress, take an Ebola inspired approach to the opioid epidemic.” He made several interesting points including the following: in 2015, the opioid epidemic claimed 33,000 American lives compared to 11,000 worldwide from Ebola from 2013 to 2016. During a period from 2014-2015, I was fortunate to serve as a White House Fellow and Acting Director for Pandemic and Emerging Threats at the U.S. Department of Health and Human Services and was intimately involved with the domestic and international Ebola response so I found this point particularly remarkable. Without question, the Ebola outbreak was a full blown international crisis, so it’s quite striking that our own domestic health crisis around opioid abuse is only now beginning to get the full attention it deserves even though the scale of magnitude is three times greater than the Ebola epidemic. I believe there are many reasons for this including the particularly heinous way that Ebola causes disease and its portrayal in popular media. At the same time, I suspect that the relatively insidious onset of the opioid epidemic and the fact that these medications are often prescribed legally by medical professionals allowed us to look the other way while it took its full hold. Either way, we now find ourselves in the midst of a national crisis that is claiming close to 100 American lives every day.
In March 2016, the Center for Disease Control (CDC) made headlines when it released it's 12-point Guidelines for Prescribing Opioids for Chronic Pain. As the opioid epidemic and chronic pain pandemic have reached record levels, state governments and professional medical societies alike have released their own recommendations and regulations to inform opioid prescribing. Here's a snapshot to help you keep track of your state's chronic pain guidelines:
The Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC) has released a new toolkit to combat opioid overdose through improved stewardship programs. The resource is designed to help providers review and assess the volume and length of opioid prescriptions and dosages to mitigate risk of patient overdose and death.
By now, much has been written about Tiger Woods and his recent arrest for driving under the influence in Florida. The professional golfer was found slumped over the steering wheel of his car with the engine still running and damage to the side of the vehicle. When officers performed a field sobriety test, his breathalyzer indicated that he had not ingested any alcohol and it is likely that he had a mixture of non-steroidal anti-inflammatory and narcotic medications in his bloodstream—some reports indicate that he was taking Vioxx as well as Vicodin (in addition to other medications). In her recent report for The Atlantic, Olga Khazan does a great service using this incident to highlight the problem of drivers not under the influence of alcohol, but severely impaired by prescription medications.
After reviewing several articles regarding the controversy chronic pain patients are facing due to physicians changing policy in fear of the CDC Opioid Guidelines, I feel it necessary to address the seriousness of turning away legitimate chronic pain patients seeking medical care, because of the perceived stigma attached to opiates.
The Hudson Institute’s recent briefing paper, “A Strategy to Counter the Opioid Epidemic: Contain, Reduce, Extinguish” delivers a clear explanation of our nation’s opioid problem, and importantly, a comprehensive approach to address the issue.
First, Let's Talk About My Pain.
Pain can be explained as either chronic or acute. Acute pain is described as pain that has just occurred after an injury such as surgery or trauma to our body. Acute pain will improve over time as our bodies heal from this injury or surgery.
A recent study published in The Journal of Pain found that patients prescribed higher opioid doses experienced greater pain intensity, higher health care utilization, and poorer quality of life. Is this a breakthrough finding or an obvious correlation?