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    What can physicians do to help curb the opioid crisis?

     

    Sullivan, for example, says his patients generally fall into one of three categories—patients whose functions can be improved with pain medications, including opioids, opiate-dependent patients who can’t function without them and people seeking to divert (sell) their medications. For patients in the first two categories, he assesses their level of opioid tolerance and how the medications affect other parts of their lives.

     

    RELATED READING: Risk management lessons from an opioid trial

     

    “Any time I see patients taking opioids, but they are fully functional in their job and able to take care of themselves, then I feel comfortable prescribing these medications,” he explains. “If I see decreased ability to function, that’s a dangerous sign and I change them to less-sedating medications as soon as possible.”

    Kushner emphasizes family histories in her patient workups, looking for evidence of alcoholism or other forms of substance abuse. “That may show a genetic link [to dependency],” she explains. “And if it looks like my patient does have the potential for addiction, I’m going to be a little more conservative with them and do closer follow-ups.” 

    Systemic challenges

    Despite their best intentions, however, doctors admit they are often hamstrung in their efforts to battle the spread of opioid abuse by the same factors that hinder other initiatives to improve patient health: lack of time and money. 

    The entire healthcare system, they say, is geared toward getting patients in and out as quickly as possible—exactly the opposite of what a patient struggling with addiction requires. 

    “A doc can say, ‘I’ll spend time talking to my patient explaining the danger of these drugs and trying to get them to go to physical therapy instead, or I can write a prescription and have them out in five minutes,’” Raspa says. “It sounds callous, but in a busy practice where you want to get back to treating patients with diabetes and heart failure, it’s a quick way to get them out of your office. Doctors are being pressured from many sides, and sometimes they don’t do the right thing.”

    BLOG: Pain is not the fifth vital sign

     

    Raspa adds that he’d address the problem by eliminating the pain scale, and anything having to do with narcotics from patient satisfaction surveys. He’d also increase the number of rehabilitation centers. “It would be nice to get people off these meds in a safe, controlled environment,” he says.

    Osborne notes that many of her patients who use opioids have “complicated psycho-social histories. Many times they’re in messy marriages and living nightmare lives,” in addition to battling problems such as obesity and smoking. Thus weaning them from the medications requires addressing the other issues in their lives, a process that requires a great deal of time and patience. 

    “I spend at least an hour with each patient, do house calls, attend school conferences, educate other providers,” she says. “That helps patients to be well and safe, and causes me to be poor, because the [healthcare] system doesn’t recognize that type of work. That’s what gets so frustrating.”  

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    • Anonymous
      don't force nurses to ask about pain
    • Anonymous
      don't force nurses to ask about pain

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