Written by: Christiana Cunningham Matoski – June 14, 2016
Opioids, such an ugly word these days. I am a nurse practitioner that specializes in chronic pain management. I see everyday the benefits and negative aspects that opioids have on people. I have been involved with pain management since the opioid Indiana guidelines were implemented. I think there were good intentions but these intentions were a bit too late. For the most part, new patients we see are already dependent or addicted to opioid pain medication. Trying to taper patients off their opioid pain mediation and using other interventional pain management treatments is a difficult task. Opioid medication should be the last treatment option for most pain management treatments other than acute reasons, injury, post operative pain management etc.
On the other hand, I have seen the benefits of opioids, increasing a patients function, providing a better quality of life. I always say opioids are a double edged sword, the good and the bad. Pain is subjective and patients are entitled to have their pain managed. So this is where it gets difficult. We have put new rules and regulations in place to help recognize patients that are being compliant to their pain management or not. The opioid guidelines has put forth an opioid agreement contract between patient and provider. This agreement lists all the rules and regulations that must be followed to obtain opioid pain medication. Some of the regulations are: random urine drug screens, running INSPECT reports ( a verification system to see if a patient has been prescribed opioids by other prescribers and when they filled their prescription). Here is an example on how these regulations don’t work: When a patient has an abnormal drug screen and we have to suspend their medication and can not prescribe them, a common response is ” I will just buy them on the streets”. Since these medications are so easily accessible on the streets, I am sure this occurs more frequently than I would ever want. Instead of being monitored by a provider, they are not monitored and taking what ever form they can get from the street. So some of these guidelines are really not helping the issue. Unfortunately, the problem has become an epidemic, and the only way to stop it is preventing the next generation from following suite.
Overdose deaths involving opioid pain relievers have increased and now exceed deaths involving heroin and cocaine combined . The epidemic of prescription drug overdoses in the United States has “worsened over the last decade, and by 2008, drug overdose deaths (36,450) were approaching the number of deaths from motor vehicle crashes (39,973), the leading cause of injury death in the United States.From 2011 and 2013, Indiana had the 15th highest rate of drug overdoses — 16 deaths per 100,000 residents “(www.cdc.gov,2016) These statistics are alarming and should be. The government, communities and law enforcement are drastically trying to come up with a plan to decrease these statistics. One way is to carry Narcan (reverses the effect on narcotics). Unfortunately this is not treating the problem but just saving a life for the mean time and hoping they don’t resort back to drugs .
We need stronger preventative programs to prevent the initial use of opioids and heroin so we don’t have to resort to narcan . We need to bring this information to elementary schools, middle schools, high schools, PTO meetings and school board meetings. We also need to greatly expand on treatment centers even in our correction facilities. As with everything we need family involvement to bring attention to these matters.