By Dr. Chris Tonozzi, MD, Director of Data Quality
Abuse of narcotic pain medication and the deaths associated with narcotic abuse have garnered lots of headlines recently. It’s been the subject of many, many hours of discussion in health care circles. We’re left to wonder: how much is media hype and how much is real concern? Does it affect us here in rural Colorado? What’s being done to address the problem?
The Centers for Disease Control and Prevention (CDC) recently released a review of the drug overdose deaths from 1999 – 2016 and the findings are dramatic. The rate of deaths in 2016 was 21% higher than the rate in 2015. The following curve displays the trend.
Where once we thought that opioid abuse was a rare disease, a disease of marginalized populations who had access to injected heroin, today opioid addiction has entered the mainstream. The National Survey on Drug Use and Health estimates that 12.5 million people in the U.S. misused prescription opioids in 2015. (The survey is carried out by the Substance Abuse and Mental Health Services Administration, or SAMHSA.) The study estimated we have two million people with a prescription opioid use disorder. 15,000 people died from overdosing on commonly prescribed opioids in 2015.
How did we get here? The information we health care providers were receiving in the 1990s and early 2000s was that we weren’t addressing our patients’ pain and they were suffering because of it. A patient’s level of pain became the “fifth vital sign” and we were asked to measure it at every interaction we had with a patient and treat with pain medication until that level was reasonable. Pharmaceutical sales representatives were pushing the latest formulations, many of which were thought to be less addictive. But as early as 2010 it was becoming clear that we had “created a monster” and we had to rethink our approach.
At Mountain Family Health Centers, we’ve strived for a balance that recognizes the legitimate need for pain relief with the caution needed to avoid addiction. Over the last 5 years we’ve taken steps to decrease the number of controlled substances we’ve been prescribing. The following graphic shows our decline in the number of controlled substance prescriptions.
To make this a reality, Mountain Family has adopted guidelines that follow national recommendations, which include the following:
- Limits are set as to the highest allowable limits Mountain Family providers can prescribe. Above that amount, patients must be referred to pain specialists.
- Providers maximize the alternatives to opioids, like physical therapy, “neuro-modulating” medication, behavioral health and chiropractic.
- Opioids are rarely prescribed with other sedating medications.
- A statewide database on controlled substance prescriptions has been established and providers check this database prior to prescribing opioids.
- Controlled substance prescribing is regularly reviewed by our Peer Review Committee which is established to ensure our care is comparable or better than care provided in similar settings.
- We’ve teamed up with other providers in the community, like the hospital Emergency Departments to ensure that we have consistent messages going to our patients regarding controlled substances.
The opioid epidemic has been devastating for many communities, and the national trends have shown a serious need to change how health care providers use narcotics. At Mountain Family, we’ve taken an objective approach that has allowed us to continue to treat pain within well-established guidelines, but also avoid many of the dangers inherent in opioid prescribing.