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Prescription medications are powerful therapies. They can cure, heal, and prevent disease. They are also being abused, and the abuse of prescription pain medicines has resulted in the needless deaths of thousands from overdose.
Addiction experts, government officials, and even some physicians, have pointed to the medical profession as one cause of the problem of prescription drug abuse. Physicians overprescribe, they say, and write too many prescriptions. But the fact that more than three out of four people who misuse prescription pain medicines use drugs that are prescribed to someone else is one indication that the problem arises from more than one single cause.
So how do physicians view the issue of prescription drug and opioid abuse?
The February edition of Physician Focus offers some answers, in a discussion among three physicians knowledgeable about the treatment of pain, pain medications, and opioid abuse.
Participating in this conversation are Richard Pieters, M.D., 2014-2015 President of the Massachusetts Medical Society and Professor of Radiation Oncology and Pediatrics at the University of Massachusetts Memorial Medical Center in Worcester; Daniel Alford, M.D., Director of the Safe and Competent Opioid Prescribing Education program at Boston University School of Medicine and the Director of the Clinical Addiction Research and Education Unit at Boston Medical Center; and program host Barbara Herbert, M.D., Medical Director of Addiction Service at Commonwealth Care Alliance and President-Elect of the Massachusetts Chapter of the American Society of Addiction Medicine.
All agree that prescription abuse, addiction, and overdose are huge problems, and the causes are complex.
“Chronic pain is common,” says Dr. Alford, “affecting some one hundred million people in the United States, and I think there’s been an overreliance on a single medication [opioids] that carries a lot of risk.” He adds that our society is lax about taking extra pills to treat symptoms, and with the case of opioids, “it can be life threatening.”
Dr. Pieters notes that how the health care system treats – or doesn’t treat – pain, along with patient expectations, are also contributing factors. “Insurance companies are more willing to pay for medication,” he says, “but don’t want to pay for other options for the management of chronic pain, such as physical therapy, acupuncture, or cognitive behavioral programs. So the easiest thing for insurance companies and the fastest thing [for pain relief] in the perception of patients is opioid pain medication.”
The physicians make important distinctions among different kinds of pain: chronic pain, which is constant and lasts a long time; acute pain, which is severe and of shorter duration; and terminal pain, such as that experienced by cancer patients.
These distinctions and the relationship between physician and patient become critical elements to physicians when deciding how to treat pain. “Doctors need to partner with our patients,” says Dr. Herbert, “to figure out what the disease is we’re treating, what is the best treatment, when opioids are the best treatment, and when they’re not the best treatment, to think about what else we can do.”
Partnering, however, can be difficult. “There are a lot of issues around trust,” adds Dr. Alford. “Patients may exaggerate their pain to let the doctor know how serious their pain is, and physicians have a lot of fear about addiction.”
All three agree that patients can play an important role in reducing opioid abuse, especially with regard to the safe storage and disposal of pain medications. Leaving prescriptions in medicine cabinets, for example, is the primary way that people who aren’t prescribed medicines get them. Storage in secure lock-boxes, returns of unused medications to police stations, and use of drug “take-back” programs are all ways to decrease the availability of the drugs and thus reduce the abuse.
The doctors also believe that the best approach to treating pain is one that combines medications with additional methods like physical therapy and behavioral treatment. At the heart of it all, however, they say that open and honest communication between physician and patient is a key element to effective and safe pain management.
After all, Dr. Herbert notes, “It’s not about the pills or the powder. It’s about the people.”
View the video above for additional discussion, including conversation about specific steps the doctors recommend for the safe management and disposal of prescription medicines; what patients should discuss with their doctor when prescribed a pain medication, the importance of not mixing substances, and the physicians’ view of the use of the prescription drug Narcan to prevent deaths from overdoses.
Text:
MMS/Richard Gulla
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