In opioid crisis, finding balance between pain and addiction
ALLENTOWN, Pa. (AP) – Dr. Kenneth Choquette knows the kind of chronic pain his patients endure every day. Without opioid pills, some cannot work, sleep or do simple chores like wash the dishes.
“If I take pain medication away from a patient who is properly taking it for the right reasons, it means they hurt more,” said Choquette, a Coordinated Health pain management specialist and a physician for three decades.
“So, are they dependent on the medication?” he said. “Absolutely.”
But are they addicted to opioids?
That’s the question facing many medical professionals in the United States, a country grappling with an opioid epidemic resulting in a death toll that outpaces car crashes. Their job is to balance patients’ needs with the possibility that opioids will be abused.
Decades ago, before the opioid crisis gathered steam, the pendulum swung toward overprescribing the drugs to quell patients’ pain. Now, some doctors say the pendulum has moved too far in the other direction, leaving their patients with less access to the medicine they need to get through their days.
“We do see those who have a true medical need being treated like drug addicts where their problem and their ongoing medical condition is no longer taken seriously,” Choquette said.
Choquette and four other medical professionals – an OB-GYN, an oral surgeon, a pharmacist and a community nurse – recently gathered for The Morning Call’s second community roundtable on the opioid crisis. They said efforts to stem the epidemic fail to balance the legitimate use of opioids by patients and illegal use of them by addicts.
Political leaders, law enforcement and insurance companies have responded with broad, shallow strokes, the roundtable participants said. The result has made opioids harder to get for patients who need them, often causing those patients unnecessary pain and leaving them feeling like criminals.
Doctors’ concerns echoed those of the first responders who convened in February for The Morning Call’s first roundtable conversation.
First responders agreed that the nation’s reaction to the unrelenting opioid epidemic, which claimed more than 300 lives in the Lehigh Valley last year, is inadequate. Using an opioid-reversing drug called naloxone saves lives, but doesn’t fix addiction, they said. They want money for treatment, laws to force addicts into court-ordered treatment and educational programs about the dangers of opioids.
Both roundtable groups want an overarching approach to the problem in which everyone linked to the epidemic works together to break through the crisis.
“It’s not a one-size-fits-all solution,” said Melissa Miranda, a nurse and the director of Neighborhood Health Centers of the Lehigh Valley.
“Every conversation should be talking about collaborative partnerships across communities,” she said. “Because this one definitely is more than one single conversation or solution.”
Some doctors are changing their practices
With no one-shot solution available, doctors have found their own ways to address the crisis. They are limiting the amount of opioids they prescribe, treating pain with other methods and talking to patients about the risks of opioid use.
Overprescription of opioids can lead to so-called “diversion” of opioid drugs. When patients have more pills than they need, those medications are at risk for abuse and illegal sale.
OB-GYNs at Lehigh Valley Health Network now prescribe fewer pain pills, Dr. Amanda Flicker said. A mother recovering from a cesarean section gets about 20 pills. Before the epidemic became a public health emergency, moms would receive up to 60.
“We may not say, ‘We’re not going to give you the opioid pain medication,’ ” Flicker said. “But we’re going to give you 20 tablets, which is what the average user will take after a certain procedure. It minimizes the rest of the bottle hanging out there in the medicine cabinet and potentially getting diverted into other hands.”
Many doctors rely on other ways to control pain, such as applying ice or heat to injured areas, physical therapy and using non-narcotic medicine to dull inflammation.
Dr. Robert Laski said he and his colleagues at Valley Oral Surgery no longer write prescriptions for pain medicine before surgery. Instead, they wait until the day of a procedure to write them. That helps prevent the pills from getting diverted.
They also use a nonopioid numbing medicine. For patients with mild pain, such as toothaches, they prescribe heavy-duty Motrin instead of opioids, Laski said.
Those kinds of efforts have yielded results at the pharmacy counter, where independent pharmacist Pauline Vargo said she’s been filling fewer prescriptions for opioid drugs.
“I have definitely noticed a trend,” she said. “When I first went into practice, they were given more freely. Now they are definitely used with more caution.”