Physicians increasingly turning to non-opioid medications
Opioid overdose deaths in the United States have quadrupled since 2000
Written By Lauren Glendenning
Brought to you by Kaiser Permanente
As the United States grapples with an opioid epidemic that has spawned a public health crisis, countless physicians around the country are trying to do their part in eliminating the potential for addiction.
Opioid overdose deaths in the United States have quadrupled since 2000, and drug overdose has become the leading cause of accidental death in the United States, according to the Centers for Disease Control and Prevention. It’s estimated that 91 Americans die every day after overdosing on opioids, which include illegal heroin as well as legal prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others.
When these opioids interact with receptors in the brain and nervous system, pleasurable effects and pain relief occur, according to the National Institute on Drug Abuse. That pleasure or pain relief acts like a reward for the brain, and those who suffer from addiction will pathologically pursue that reward or pain relief, according to the American Society of Addiction Medicine.
Opioid addiction is often considered a modern problem, but the use of opium dates back thousands of years, said Dr. Carol Venable, Internal Medicine Physician with Kaiser Permanente’s Frisco Medical Offices. She said present-day use, however, has reached epidemic levels.
“Most health care providers I know have been trying to address this issue for their entire professional careers,” Venable said. “Every practice I have worked in as an attending provider has utilized opioid agreements between providers and patients, urine drug screening and careful monitoring.”
Any opioid medication can be abused, and even short-term use can lead to addiction. Patients who are most at risk for developing an addiction to these medications include those with a history of substance abuse, overdose, prescription misuse, a family history of substance abuse or a person history of a psychiatric disorder, Venable said.
“Prior to giving prescriptions for opioid pain medications, we screen for risk factors for dependency,” she said. “In addition, we try to give patients clear information on medication tapers and help them taper off these medications as quickly as possible.”
Kaiser Permanente has worked hard to provide resources for patients and providers about opioids, Venable said, adding that physicians are extremely cautious about long-term usage of any opioid medication. Physicians do not place refills on opioid medications, but instead taper the patient off the medication quickly or put a long-term taper plan in place, she said.
“We now have a comprehensive program in place to help minimize risk to patients, educate patients about different pain management options, and care for the few patients who may need opioids for some period of time,” she said. “We have a variety of tools built into our electronic medical record for this as well. We also use Colorado’s Prescription Drug Monitoring Program (PDMP) to make sure our patients are receiving controlled substances only from one provider.”
It’s up to physicians to communicate about a patient’s plan for pain management. A surgeon treating someone for postoperative pain should be in contact with the primary care provider to make sure everyone is on the same page, said Dr. Jeannine Benson, Chief of Primary Care at Kaiser Permanente’s Edwards Medical Offices.
For patients suffering from chronic pain, physicians need to guide them toward lifestyle changes, as well as explore alternative therapies. Patients also need treatment for any mental illnesses, Benson said.
“Physicians also need to set the expectation for appropriate levels of pain control,” she said. “Fulfilling an expectation of complete resolution of chronic pain often leads to over-medication.”
Physicians at Kaiser Permanente try to incorporate alternative medications as much as possible. Venable said there are several other types of pain medications that are not dependency-causing, as well as many non-pharmacologic interventions that also can be helpful.
“We have a team approach to pain management, and we make sure every member of our healthcare team is educated on how to help patients achieve successful pain control while minimizing the need for dependency causing medications,” Venable said. “We also spend a lot of time educating patients on risks and appropriate usage, as well as the ultimate goal of tapering off of the opioid medication.”
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