New Kit Helps Doctors Reduce Opioid Prescriptions to Prevent Addiction, Overdose, and Death
Exact statistics are not available on this, but it is very clear that a good number of people who get addicted to prescription painkillers started their journey by getting a prescription from their doctor. How can that possibly result in the patient getting addicted? And what can doctors do about it?
A friend of mine was operated on about a year ago and is still complaining of pain. The doctor just keeps giving her painkillers – has not suggested any therapy or other treatment, even though it’s a situation that could be relatively easily handled. Chiropractic, acupuncture, physical therapy, safer or more natural painkillers, other nutrients, specific exercise programs – there are many things that could be done that might even heal the painful area but, at the very least, could relieve the pain without heavy drugs.
But the doctor has never mentioned any possibility for her other than the drug. And she’s the type of person that is very open to those other possibilities. Unfortunately, they are not areas in which the doctor has been at all educated.
So, I would say that number one in getting doctors to reduce addiction would be to teach them about treatments that are alternatives to drugs. Of course, this is going to have to become part of a doctor’s education. It used to be, but is no more. However, that education is pivotal, and very worth it.
According to a recent article in Pain Medicine News, a CDC study found that for every day someone takes prescription painkillers, their chances of becoming a ‘chronic opioid user’, – aka, an addict – increase. The risk gets higher starting on day three. The chances increase exponentially: again when the patient receives a second prescription; when they’ve been given high cumulative doses (e.g. the dosage increases with repeated prescription; and when they’re given prescriptions for long term.
Getting a prescription for two days is pretty unusual. Even a dentist is likely to give one for three days.
And it’s not uncommon for dosages to be increased since the body builds a tolerance to the drugs and more are needed to have the same effect as they did in the beginning.
As for repeated and long-term prescriptions, my friend has had several, and the last one was for three months.
To try to help doctors avoid these situations, the Accreditation Association for Ambulatory Health Care (AAAHC) has released a new ‘tool kit’ that helps educates doctors on the drugs, on how to prescribed them, and on addiction.
The kit includes:
- prescriber resources for calculating safe opioid dosage
- an assessment tool for gauging patient pain and function
- a primary care checklist when considering long-term opioid therapy and reassessment
- a surgical care checklist when addressing acute post–surgical/procedural pain
- tips for discussing pain management options with patients.
There is also a desire to move away from doctors judging whether or not someone should get painkillers based on their ‘pain score’. If you’ve been to the doctor for anything that could involve pain at all, you’ve been asked to rate your pain level from 1 to 10, 10 being the worst. The number that the patient gives the doctor is the basis on which the doctor decides how much of a painkiller to give the patient. For example, if the patient says their pain is below 5, they get dosage X, a low-ish dose. If they say it’s above 5, they get a higher dose. To get the drugs, all the patient has to go is tell the doctor their pain level is six and they’re pretty well set up. If the person wanted more, they could say it’s eight.
I’ve tested this myself going to doctors. I’ve asked them whether the patient is supposed to give them a number based on right that minute – when they have even taken a painkiller, or just exercised, or they’d been lifting things the day before so their back is in usual pain today, and asked them about other examples.
The amazing thing is that they don’t care. They have all said those things don’t matter – just give me a number.
Naomi Kuznets, PhD, vice president and senior director of the AAAHC Institute for Quality Improvement, in Skokie, Ill is also concerned about this type of testing. “Postsurgery pain management is not about achieving a specific pain score,” she said, ”but rather improving postoperative function and enabling rehabilitation while keeping the patient comfortable. Providers should assess both pharmacologic resources as well as patient education when developing a perioperative pain management plan.”
Let’s hope this is taken to heart.
The kit, called the The Opioid Stewardship Toolkit, is available for $10, and can be ordered from the AAAHC website.
Check if your doctor has one and, if not, make sure he gets one. He could wind up saving your life or the life of something you love using that kit as his guide.
And if you know someone for whom addiction is already a problem, contact us to find out about a good drug rehab program in your area.