Page 4 - Volume 68 Number 4
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President’s Message
by Brad J. Uren, MD
Addressing the Opioid Crisis and the Role of the Physician
In the mid-1990s, well inten- tioned patient advocates embarked upon the “pain is
the 5th vital sign” movement. The Veterans Administration Health System adopted these measures. The Joint Commission began to include pain assessment and treatment as metrics in their accreditation surveys. The California legislature adopted a law stating, “ It is the intent of the Legislature that pain be assessed and treated promptly, effectively, and for as long as pain persists.”
There are well documented cases of proponents using small, limited power studies to estimate the risk
of opioid addiction as being much lower than we now understand it to be, rationalizing the liberalization of opioid prescribing.
The Centers for Medicare and Medicaid Services (CMS) has included questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey, which will determine reimbursement rates for hospitals, a question asking patients, “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” While some point out that the survey does not specifically mention opioids, the use of the term “everything they could” signals an expectation to utilize opioids to many observers.
Twenty years into this experiment, we can offer a critical appraisal of these policies. The CDC summarizes this very well. Between 1999 and 2014, sales of prescription opioids have quadrupled. Despite these
numbers, with Americans – at less than five percent of the world’s population, consuming over 80 percent of the world’s opioids – there has been no significant change in the amount of pain Americans report. The most tragic metric is the quadrupling of opioid related deaths over the same time span.
Opioid related deaths are now outpacing motor vehicle collisions
as a cause of death in this country. Increased prescribing has failed to improve the reported pain Americans experience, but the increase in mortality demands a response from us as responsible physicians. We must do better for our patients, and resist forces that would ask us to
do otherwise.
There are a number of ways physicians can take action now
to address the opioid crisis. The American Medical Association has issued the clearest guidance. During the end of his president’s year, a fellow emergency physician, Dr. Steve Stack, issued an open letter
to all physicians in May 2016. In his letter, he laid out several best practices and calls on physicians to begin these best practices immed- iately. The entire letter can be found at Dr. Steve Stack’s Open Letter on the Opioid Epidemic.
It is the role of every physician to make a careful, compassionate, medical judgement for each patient that they see as to the risk vs benefit of prescribing an Opioid. By ensur- ing that we limit the use of these powerful medicines to cases where the medical benefits are clear and evidence based, we can limit the
unintended harm that may accom- pany use of these medications.
In a 2009 study, up to a third of patients that received a narcotic prescription were at risk of non- medical use of a narcotic medicine in the next year. Evidence has shown that people who begin to misuse opioids will begin with prescription medications that are used non-medically, and are obtain- ed or stolen from a friend or relative, often from a medicine cabinet or other unsecured location.
Encourage your patients to properly discard of any unused medications. There are many options for this that can be found in the following links:
FDA Drug Resources Michigan State Police Drop
Off Centers
Washtenaw County Medication
These surplus medications are one more reason it is so important to ensure that prescriptions we write are appropriate, limited to the min-
Washtenaw County Medical Society BULLETIN

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