Doctor: Following guidelines, identifying risk factors result in safe use of medication
The statistics are shocking.
Every day, more than 130 people in the United States die after overdosing on opioids, according to the National Institute on Drug Abuse.
In an article for Morbidity and Mortality Weekly Report, it was reported that from
1999-2017, almost 400,000 people died from an overdose involving any opioid, including both prescription and illicit opioids.
Dr. David Best, of Best Medical Services in Traverse City, serves on the Michigan Osteopathic Association Safe Opioid Task Force, which is working to reduce opioid-related deaths. There were five items of discussion the task force focused on and determined help achieve that goal:
- First things first – prevent death with opioid-overdose antidote naloxone.
- Stabilize addiction with medication-assisted treatment.
- Establish long-term person-centered treatment goals for successful recovery.
- Change opioid prescribing practices.
- Shrink the supply of and demand for illicit drugs.
What makes opioids so addicting is the medication not only affects the pain receptors, but also the regions in the brain that control reward, decision-making and impulse control. In cases of addition, the drug becomes the most important factor in a patient’s life and has a negative effect on the other aspects of his or her life, said Best, who is board certified in family medicine and addiction medicine.
“Ten to 20% of the population will have a greater likelihood of developing an opioid use disorder, which is about the same percentage of people who drink alcohol that will develop an alcohol use disorder,” Best said.
There are safe ways to use opioids to reduce pain.
Best said physicians treating patients with severe or chronic pain should follow the guidelines established by the Centers for Disease Control and Prevention for prescribing opioids for chronic pain.
“Assess the pain severity and make sure a detailed history and physical is obtained,” Best stated. “Is the injury or pain condition severe enough to warrant using a high-risk medication for pain management?”
Best explained the best practice would be to consider other treatment options, such as nonopioid pain medications or nonmedication strategies, including physical therapy, injections, osteopathic manipulation, chiropractic treatment or acupuncture.
Best also said physicians should use a risk assessment tool to ensure the benefit clearly outweighs the risk.
“I used the DIRE score risk tool, which stands for diagnosis, intractability, risk and efficacy,” Best explained. “A score ranging between 7 and 21 can be obtained from asking seven separate questions. A score of 14 or higher would be where the benefit likely outweighs the risk.
It’s also important that patients do not have unrealistic expectations.
“Patients need to be aware that complete elimination of the pain is not the goal,” Best noted. “Rather, getting the patient to a point where they can function in their daily activities and have improved quality of life is the goal.”
If it is determined opioids are the solution, Best said doctors need to go “low and slow,” prescribing less than a seven-day supply of medication for acute pain and reassess the situation before renewing the prescription. For chronic pain, an assessment every one to three months will help guide a safe treatment plan.
Best said measures must be taken to ensure a patient is not obtaining opioids from another physician, which can be achieved through a drug-monitoring program such as the Michigan Automated Prescription System. He also said the state mandates the patient sign an opioid consent form before receiving the medication, and a separate controlled substance agreement should be reviewed and agreed upon prior to a prescription being written.
“Urine or saliva drug testing should be done at least one time per year and more frequently based on risk assessment,” Best said. “Pill counts are another compliance monitoring tool and should be requested if there is suspected diversion or a report of medication misuse.”
Best said, in some cases, the pain becomes so intense that a patient has thoughts of suicide.
“This is where empathy is very important,” he said. “Having a nonjudgmental approach is key and much appreciated by the patients.”
He said more work needs to be done and, through education, “more people can gain a better understanding about opioid prescriptions and the risk versus benefit discussion that need to occur for all prescribing” opioids.
Where to seek help:
Call the Michigan Substance Abuse Hotline at (800) 662-HELP (4357) Go to michigan.gov/opioids/0,9238,7-377-88140—,00.html for a list of licensed treatment facilities by county.