America’s Opioid Crisis

Written by Brent Rutledge, RPh, PharmD

Mark Twain once said, “Be careful about reading health books, you might die of a misprint.” While that might not be entirely accurate, it is safe to say that when a group of people become concerned about a subject, an underlying cause usually exists.

Today in healthcare, one of those subjects is prescription pain medication, also referred to as opioids. Statistics vary but when we look at all deaths related to opioids, including heroin and fentanyl, we see that the number has more than quadrupled since 1999. The Centers for Disease Control (CDC) logged 42,000 opioid-related fatalities in 2016. That same year, 40% of all opioid overdose deaths — about 17,000 — involved prescription pain medications. That is approximately 47 people per day, every day of the year.

The topic is of concern nation-wide and physicians and hospital staff, including locally at UMH, are challenged to provide safe and effective pain management in the midst of the heated conversation. Our hospital has proactively begun taking steps to treat patients safely and effectively despite the complex process associated with pain management and opioids.

If a patient arrives at the hospital in acute pain, the hospital will treat their pain. When used appropriately, medications, including opioids, are an integral part of making a patient better. But new regulations have changed the way we treat pain and hospitals are now required to identify patients that are at high risk for opioid abuse. Regulations require healthcare providers to consider things like: 

• Is the patient here for chronic pain?
• Has the patient been admitted to the hospital for chronic pain in the last year?
• Does the patient have multiple prescriptions for pain medications?
• Is the patient asking for specific pain medications?

Many factors are taken into consideration and a person identified at high risk for opioid abuse is then referred to their primary care physician (PCP) or a pain management specialist. For people with chronic pain or disease repeated trips to the Emergency Room are usually not beneficial. These patients will benefit the most from seeing their PCP or a specialist for long term treatment.

Providers will often look to alternative methods to treat pain. Many effective pain medications exist that will not cross over into the brain and affect the central nervous system like opioids do. Opioids also often have side effects like constipation and upset stomach that can be avoided with alternative treatment. Alternative treatments may not always be popular with the patient but are certainly in their best interest.

Hard data has taught healthcare providers to use the minimal amount needed of an opioid for the shortest time possible. This practice is twofold: it can help a person who is currently addicted, or it can prevent another person from having a future problem.

No one would want to imagine life without pain medication, and why should we when medicine has come so far. However, treating pain does not necessarily mean a patient will have zero pain. Pain is a natural and important part of the human experience. In many cases pain teaches us not to repeat whatever action caused the pain in the first place.

If there is anything I have learned as a pharmacist in over 25 years of dispensing medications, it is to have a healthy respect for what they can do to human beings.

A discussion with your local pharmacist and/or your healthcare provider is always a good idea if you have any concerns regarding your pain or your treatment.