By: Margaret Walker (Medical Student, Feinberg School of Medicine)
Two weeks ago, the Northwestern Pritzker School of Law and Feinberg School of Medicine jointly hosted the Opioids Symposium with the goals of sharing knowledge across disciplines and discussing solutions to the current opioid addiction crisis. I attended a session that attempted to dissect the issues related to balancing clinical pain management care and opioid addiction. A panel of four experts discussed three key issues related to this topic: pain management, addiction, and associated public policy and advocacy trends.
- Patrick Lank (Moderator)
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine
- Gregory Teas
- Psychiatrist, Alexian Brothers Behavioral Health Program
- Patrice A. Harris
- Chair of the American Medical Association Board of Trustees
- Darlie Simerson
- Nurse Practitioner at Loyola University Chicago Marcella Niehoff School of Nursing
Pain is interesting as it is a biopsychosocial construct, and not everyone experiences pain in the same way. Unfortunately, the medical profession has only a few (limited) tools to assess pain. These include subjective pain scales and an “internal sense” of what is right. The practitioners also discussed using the Illinois prescription drug monitoring program (PDMP). This program helps to track the number and type of opioid prescriptions per person throughout the state. It allows providers to check how often patients are requesting and receiving these regulated drugs. Frequently, patients come into the emergency department or clinic requesting opioids by name. This is either because they are already addicted, looking to overdose, planning on selling, or are truly in pain. Providing opioids seems to be an effective technique in providing pain management for acute pain but is more limited for chronic pain. Taking into account all of the challenges of assessing pain and the current issues in our country, there is a need to establish standards of care that attempt to limit opioid use. Currently, the CDC does have a guideline, but systematic changes and policies are needed to help change the culture.
A couple of decades ago, there was a push to treat pain more aggressively. At the time, there was an underestimation of opioid addiction susceptibility and oversold benefits of opioids as pain killers. Now the US prescribes 80% of the world’s opioids, and 78 people die everyday of opioid overdose. Two other contributing factors have been a lack of education on opioid use in medical training settings and a focus on patient satisfaction. Subsequently, the US finds itself dealing with this addiction epidemic.
The panel put forward a few suggestions for how to reduce opioid addiction in the population. One of the largest suggestions was to just avoid initiating opioid use. Alternative methods of pain management, such as acupuncture, may be just as effective as opioids and not have the risk of addiction. Screening for addictive tendencies or history of trauma was proposed as a way to identify individuals with a predisposition to addiction. Other suggestions included reducing the amount of drug actually given to a person, limiting it to a 3-7 day quantity. This would be an effort to reduce the amount for diversion or sale. Finally, the panel warned against over correction. Pulling people off of opioids “cold turkey” can lead to a conversion to illicit forms of opioids including heroin. In addition, the matter of opioid addiction needs to be handled delicately. The goal is not to introduce shame or stigma but rather to help individuals live pain and addiction free.
Public Policy and Advocacy
Patrice A. Harris, speaking on behalf of the AMA, discussed the key goals that they are working towards. These include: increase PDMP use across the country, encourage evidence-based pain management for the individual, avoid stigmatization, increase the distribution of naloxone, and improve cultural competence. Harris discussed the need for “action-oriented” policy as opposed to “feel-good” policy. Meaning, there is a need to develop policy that can be easily and efficiently enforced leading to a change in behavior and health outcomes. In this case, much of the policy is focused on improving, standardizing, and authorizing PDMPs. In order to achieve the other goals, the AMA is partnering with many other state and national professional societies. The profession as a whole is working together to build standards and responsible prescribing practices to improve the health of patients.
This final thread clearly outlines the need for involvement from those outside the medical profession. Physicians are great at intervening at an individual health level, but this problem is so much larger. Public health programs and policy are needed; we need qualified lawyers, social workers, first responder, teachers, and advocates. It is through different ideas and perspectives that we can begin to better manage pain and reduce the risk of addiction.
Picture by Pixabay via Pexels: Creative Commons