But a new standard involves helping a patient improve function, not necessarily eliminating pain

Doctors prescribe fewer opioid pain killers, but experts say it’s not enough

http://www.dispatch.com/news/20170729/doctors-prescribe-fewer-opioid-pain-killers-but-experts-say-its-not-enough

The amount of opioid pain killers prescribed in Franklin County dropped by 41 percent from 2010 to 2015, but doctors still were prescribing the equivalent of a 14-day supply of the drugs for every person in the county, according to federal data.

Across Ohio, prescriptions for opioids decreased by at least 10 percent in all but 13 of 88 counties. In nine counties, the rate remained relatively stable. In four others — Hocking, Morrow, Ottawa and Van Wert — prescriptions for opioids increased by at least 10 percent, according to the Centers for Disease Control and Prevention (CDC).

Ohio Attorney General Mike DeWine said the numbers are consistent with what he sees when he travels the state.

“We have started to turn this around, but it’s tough to change the culture, and the culture in this case I’m talking about is the culture of prescribing,” he said. “We’re moving in the right direction, but we still have a ways to go.”

Across the country, the amount of opioids prescribed dropped by 18 percent. Prescriptions hit a high of what would be the equivalent to 782 milligrams of morphine per person in 2010, falling to 640 by 2015. That’s still three times higher than it was in 1999, said Dr. Anne Schuchat, principal deputy director of the CDC.

While nearly half of all U.S. counties saw a significant decrease in prescriptions from 2010 to 2015, nearly 23 percent saw an increase of at least 10 percent, according to the numbers, based on raw prescription data obtained from QuintilesIMS, a pharmaceutical analytics company.

A crackdown on the unnecessary prescription of drugs has gone on for years as law enforcement officers and state legislatures seek to curb the deadliest drug overdose epidemic in U.S. history. Users of the drugs often become addicted to the prescription pills and then move on to opioid-based street drugs, DeWine said. Three-fourths of people addicted to heroin or the far more powerful fentanyl and carfentanil started with pain medications, he added.

Doctors have become increasingly aware of the opioid problem with the knowledge that 15 to 18 percent of people are susceptible to developing a chemical dependency, said Dr. Steven Severyn, director of the Pain Services and Pain Medicine Fellowship at Ohio State University Wexner Medical Center.

As such, they have come to think not only about clinical risks when prescribing the drugs but also about risks to the community and society at large.

“Prescription narcotic medication really is the dominant form of narcotic use, at least early in drug addiction,” Severyn said. “Physicians are responding to that understanding by being certain that the use of medications for the treatment of pain is appropriate in dosing and frequency and, especially, escalation.”

In Ohio, Jackson County topped the 2015 list, with doctors prescribing 1,582 morphine milligram equivalents per person, representing a 33-day supply of the drug for each resident. Others at the top were Jefferson, Washington, Pike and Ross counties.

Vinton County (pop 13,000) saw a 98 percent decrease from 2010 to 2015, dropping to 6 morphine milligram equivalents per person, the lowest in Ohio. Also at the bottom were Holmes, Noble, Paulding and Mercer counties.

In central Ohio, decreases were seen in Delaware (30 percent), Fairfield (28 percent), Licking (19 percent), Pickaway (24 percent) and Union (15 percent) counties. Madison County remained relatively stable, with an increase of just 2 percent. Still, the counties each prescribed the equivalent of at least a 10-day supply of the drugs for every person in those counties in 2015.

Severyn noted that pain medications are still being prescribed because they are the only option for some people who are suffering.

“The other side of the argument, and the difficulty with pain medication, is that often it is the only tool that we really have for the treatment of painful conditions,” he said. “They’re very necessary.”

But a new standard involves helping a patient improve function, not necessarily eliminating pain. Severyn said his program prescribes as few opioids as possible, using other pain management techniques, including surgeries, psychological support, physical therapy, injections, nerve ablation and device implantation.

Physicians have taken a lead and become accountable in addressing the opioid problem, but more needs to be done, especially when it comes to the amount of attention and resources focused on treating people who are addicted, said Reginald Fields, Ohio State Medical Association spokesman.

He said the association assists doctors by offering Smart Rx, an online training program that helps health-care providers stay up to date on rules and regulations regarding opioids. It also gives them best practices for treating pain and offers tips on how to educate patients about the opioid problem.

Also addressing the problem is the Ohio Board of Pharmacy, which has developed prescription guidelines targeted to emergency departments and to physicians who handle chronic or acute pain, said spokesman Cameron McNamee. The board also offers education on best practices, encouraging doctors to look at alternatives before prescribing drugs.

McNamee said the board also focuses on regulations. He pointed to 2014 Ohio legislation that requires doctors to use a prescription-drug monitoring program, which allows them to track whether a patient has received prescriptions from other health-care providers. A proposal going before the legislature’s Joint Committee on Agency Rule Review this week would limit the amount of opioids that can be prescribed for acute pain, he said.

“A vast majority of people that develop addiction and move on to heroin or fentanyl use start with prescription opioids,” McNamee said. “As we make progress in reducing the amount of legal opioids prescribed, we will start seeing an impact in the amount of people dying of heroin and fentanyl overdoses.”

1,582 morphine milligram equivalents per person, representing a 33-day supply of the drug for each resident.

This calculates to 48 mg/day morphine.. and that is what some BUREAUCRATS considers a typical appropriate number of mg of Morphine to treat chronic pain pts.  Giving a pt a Morphine ER 15 mg every 8 hours – MIGHT – help the pt deal with mild-moderate pain.

It would appear that those chronic pain pts suffering from mod-severe pain would have to deal with a new standard involves helping a patient improve function, not necessarily eliminating pain..

8 Responses

  1. […] BUT… Dr. Steven Severyn, director of the Pain Services and Pain Medicine Fellowship at Ohio State University Wexner Medical Center. Believes that new standard involves helping a patient improve function, not necessarily eliminating pain.. http://www.pharmaciststeve.com/?p=21495 […]

  2. Like I said before, there are going to be millions of people applying for Social Security Disability due to an inability to work due to chronic pain. I am a retired Social Security Disability Adjudicator and pain must be considered in the final disability determination. I do not think anybody in the government has considered any of this. Frankly, I would not be surprised if the government changes this in the future making pain “no longer” a consideration seeing the way other things have gone.

  3. They keep using the same old fake lines, fake numbers etc. They need to move on to what is really happening and leave pain patients alone. We are not expecting “pain free”. We expect to be able to go to a highly trained doctor and be treated for our incurable, painful diseases. Walk a foot in our shoes and you would be at the ER, demanding pain meds. When it happens to you, and you are denied, remember all the “hysteria” you continued to provoke.

  4. Yup once again , patients automatically move on to hard drugs because of rx?? You are so full of it. Get educated already. I have been on opiate pain medication for 20 something yrs and NEVER tried anything harder due to being on them.

  5. “Three-fourths of people addicted to heroin or the far more powerful fentanyl and carfentanil started with pain medications, he added.” …

    They’re always leaving out that very important fact that 3/4 of those addicted to heroin and/or illicitly-produced fentanyl first MISUSED/ABUSED pain medications. Even more important, most of those obtained those medications in an illegal manner (stealing them, buying them, faking pain, etc).

    In other words, those who moved on to heroin ALREADY had addictive tendencies by ABUSING pain medications. They were not injured and given a prescription for pain. They used the pain medications for non-medicinal purposes for the sole purpose of obtaining a high.

    Most likely, they also have this in common with each other – when they were young teens, they first intoxicating substance they were introduced to was a very legal, cheap and accessible substance known as alcohol. Alcohol still remains the #1 intoxicating substance of abuse.

    http://archive.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf

  6. U CANNOT FUNCTION IN PHYSICAL PAIN…….DAHHHHHHHHH,,,,maryw

    • Mary, I was just about to post the same thing. When one is in severe pain, they’re unable to function. Reduce their pain down to tolerable levels and bam! it will restore their ability to function to the best of their physical ability. Dear God, how is that so difficult for these idiots to understand???! It’s common sense, which is something these idiots weren’t born with (or are too corrupt to use).

  7. What KILLS me every time I read about the Morphine Equivalent thingy is that it’s a MYTH. There is NO scientific evidence that supports the conversion of one narcotic to another and to use Morphine as a standard is illogical.

    My brother was a CNA for decades. He told me many years back that he saw many patients end up over dosed due to not being able to appropriately convert drugs. He said he also saw many patients left to suffer in pain because they became under medicated.

    This madness needs to be put to bed once and for all.

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