Pubdate: Wed, 11 Jan 2017
Source: Baltimore Sun (MD)
Copyright: 2017 The Baltimore Sun Company
Author: Amar Setty


Op-ed: Physician anesthesiologists can help fight opioid abuse.

The opioid dilemma puts pressure on every physician to pause and reflect.
Physician anesthesiologists are dedicated to providing pain relief in the
safest manner possible, which includes prescribing and managing opioid
therapy when medical conditions warrant. What we face now is too many
tragic instances of patients emerging from pain treatment regimens only to
see their lives destroyed later through addiction.

Opioids include illegal heroin and prescription "pain killers" such as
oxycodone, and the impact of these drugs is clear in Maryland and
elsewhere. The numbers of opioid-related deaths statewide increased 23
percent between 2014 and 2015, and have more than doubled since 2010,
according to the latest Maryland health department report released this

This month, the Centers for Disease Control and Prevention released new
data that show overdose deaths associated with prescription and illicit
opioids increased nationwide to 33,091 in 2015. Explaining that illegal
and legal opioids "are intertwined and deeply troubling problems," CDC
Director Tom Frieden said the epidemic continues to worsen.

Some may not see the connection between legal prescription opioids and
illegal opiates, yet the link is clear. The New York Times reported a year
ago that a stunning 75 percent of heroin addicts used prescription opioids
before turning to heroin, a lower-cost alternative.

How did this happen? In the early '90s, there was general under-treatment
of pain. "Opiate phobia" -- or fear of addiction -- kept pain untreated.
There was a perception that people who needed opioids were "weak."
Crippling pain from trauma to cancer went either untreated or poorly
treated. Then we over-corrected.

By the mid '90s, the push was on to treat pain. It became the "fifth"
vital sign and a marker for quality and patient satisfaction.
Pharmaceutical companies created newer versions of short- and long-term
opiates, and stoked public demand for pain relief and physician guilt for
inadequate treatment. The recent push for better "report cards" from
patients, as well as fears of liability for inadequate pain relief, led to
greater writing of opioid prescriptions. For some bad actors, all out
greed led to the creation of "pill mills" which marketed themselves as
pain clinics.

A federal Health and Human Services Department report found that in an
effort to improve pain management, the increase in prescription opioids
led to a significant rise in adverse health consequences, including
addiction, abuse and overdose. Against this backdrop, it was inevitable
that problems would develop. In the Baltimore area, ready access to opioid
pills on the street combined with cheap heroin unleashed challenges
affecting professions ranging from public safety to health care providers.

Equally challenging, we cannot simply stop prescriptions. When it comes to
chronic pain and the prospect of long-term use of opioids among our
patients, those of us in the medical community are working to address
addiction. Physician groups, such as the Maryland Society of
Anesthesiologists (which represents physician anesthesiologists who are
board certified and trained in pain medicine) are taking a lead in this
process to advocate for patient safety and educational programs.

Where to start? First, the CDC adopted guidelines this spring to
appropriately prescribe opioids. Educating the public about the
availability of non-opiate pain medicine, therapies, rehabilitation and
procedures to alleviate pain is enhanced with the support of the nation's
lead agency charged with protecting public health.

Joining other medical specialists, physician anesthesiologists are raising
awareness and defining solutions for prescription opioid abuse.
Prescription drug monitoring programs analyze electronically transmitted
data by pharmacies and dispensing practitioners. Maryland's Prescription
Drug Monitoring Program became operational in 2013. This system, along
with another electronic patient record system that connects 46 acute-care
hospitals, enables detailed prescription drug history for each patient who
will be prescribed an opioid. This system provides interoperability to
share health data among Maryland physicians, hospitals and other health
care providers.

Physicians are able to access databases prior to writing any
prescriptions. Patients who appear to be abusing opioids or other drugs
will be monitored and referred for counseling, detoxification or
treatment. Future developments will include data analytics to identify
patients at risk of abuse so they can be given the resources necessary to
ensure safe pain relief.

Physicians take the Hippocratic Oath vowing to "first do no harm." Current
prescribing habits and expectations have indeed caused harm to individual
patients, communities and our society as a whole. Physician
anesthesiologists are experts in acute and chronic pain management and
well-accustomed to working in medical teams. This approach has led to
continuous improvement in patient safety and reducing anesthesia mortality
rates. We will accept nothing less in stopping prescription opioid abuse.

Dr. Amar Setty is the president of the Maryland Society of
Anesthesiologists. He can be reached at  ---
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