How Physicians, on the Front Line of Narcotics Prescribing, are Working to Fight the Opioid Epidemic

Mar 28, 2017

Hydrocodone
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The name of the person in this story struggling with addiction has been changed to protect his identity

Prescription opioids help people deal with pain, but more and more people are abusing them, and some are dying from their addiction.  According to the Centers for Disease Control and Prevention, prescription opioids, such as hydrocodone and oxycodone, continue to be involved in more overdose deaths than any other drug.  And prescription drug abuse is a key risk factor for heroin addiction.

"Ryan" is a 25-year-old Springfield resident who started abusing prescription drugs at age 14. 

"A friend in middle school gave me hydrocodone that they had for, like, a toothache, and using that one night, it was just really enjoyable," Ryan said.

That abuse of prescription opioids eventually led Ryan to heroin, an addiction he currently struggles with.

According to the Centers for Disease Control and Prevention, people who are addicted to prescription  opioid painkillers are 40 times more likely to become addicted to heroin.  

Data from the CDC show that, from 2000 to 2015, more than half a million people died from drug overdoses, and “overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths.”

This begs the question:  if prescription drugs are being abused on an increasing basis, what can be done to make sure they don’t get into the wrong hands?

Dr. Jennifer McNay, a physician at Mercy Springfield, said addressing the problem needs to start with the physicians who prescribe opioid medicine.

"Many, many of our patients who end up becoming addicted or having issues with this class of drugs, you know, many start very legitimately with an injury or, you know, a fracture or something that requires pain control," said McNay.

According to McNay, national data show prescription opioids are being and have been overprescribed. 
CDC data show that, in 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. 

McNay said upfront training and upfront appropriate prescribing and risk assessment are “a huge piece to try to help us curb this problem.”

Education programs are key, she said, as well as having appropriate guidelines on opioid prescribing in place.

"The CDC's guidelines that have been published.  National attention that has been brought to this problem is very helpful to us.  There are many educational programs that can give us the background and the tools that we  need to make sure we put into our work flows the processes needed to help us," McNay said.

The U.S. Surgeon General Vivek Murthey sent a letter to physicians nationwide last August calling on their help “to solve an urgent health crisis facing America:  the opioid epidemic.”  He urged them to take a pledge   to educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and provide or connect them with evidence-based treatment; and talk about addiction as a chronic illness not a moral failing. And he suggested following the CDC's Opioid Prescribing Guidelines.  

At Mercy, McNay said there are risk assessment tools available to help physicians determine which patients might be at risk for abusing prescription drugs.

"Many of these tools are sort of risk assessment calculators that we can use that go through items and symptoms, history and so on of that particular patient's situation and past experience that help us essentially calculate what that patient's risk might be for abherrant behavior with these types of medications," said McNay.

And she said they have a process by which those who prescribe prescription drugs communicate to patients the risks and benefits of opiates and opioids.  That’s especially important, she said, for patients who require them for a chronic condition.  Drug screenings are sometimes done to make sure patients are using the prescriptions appropriately.

But she realizes that physicians can do all that and still have patients who will have problems.

"When patients go beyond what we feel is safe for them, we have pain clinic professionals who can help us monitor these patients and help us with what is felt to be safe regimens and other, you know, non-medication alternatives for pain control," said McNay.

Dr. Paul Thomlinson, a psychologist and acting president and CEO of Burrell Behavioral Health, addressed Springfield City Council recently, just before a vote to apply for grant money to establish a prescription drug monitoring program.  He said Burrell recently instituted a urinary drug testing policy to help the organization track patients on prescription meds.

"So, all of our prescribers, if they're going to keep someone on a controlled substance, we require that they do urinary drug testing," he said.

He looked at data for one month and found that less than 25 percent of those scheduled to be tested showed up.  In some cases, a prescription medicine someone is supposed to be taking didn’t show up in the test results, which could mean they’re selling the drugs.

He said that’s just one thing they use to try to keep patients from abusing prescription medicine, but a prescription drug monitoring program would be another useful tool in the prescriber’s toolbox.