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On May 15, 2016 I had the unique opportunity to meet and talk with the United States Surgeon General, Dr. Vivek Murthy. We had a significant discussion on an important initiative and study his office will be undertaking and creating awareness for: the topic of substance use, addiction, and health. Opioid medication abuse has significant detrimental side effects and creates many preventable tragedies. Overdose incidents occur up to every 19 minutes in our country. Narcotic medication use and abuse has risen dramatically and has now become a national concern of epic proportions. Potential reasons for this include increased priority on pain control as quality measure, pharmaceutical company marketing, and physicians not understanding the nuances of prescribing narcotic pain medications. More and more news stories are being reported on the subject and there has been a new focus of literature in medical journals and physician seminars on the topic.
As a practicing Orthopaedic Surgeon for 7 years, the most common presenting patient complaint I see is that of pain. Pain in the neck, back, arms, and legs are the most common symptoms that I evaluate, diagnose, and treat on a daily basis. Treatments consist of activity modification, bracing, icing, therapy/exercise, medications, injections, and surgery. Medications in most cases are limited to anti-inflammatory medications. However, a significant quantity of patients do have persistent pain and either need or want stronger opioid medications to help relieve their symptoms. From this, the path to opioid medication abuse can unfortunately develop in certain individuals. So how does one prevent going down this treacherous pathway?
– Education and prevention are the initial keys to reducing this problem. Communicating the pitfalls and risks to patients, as well as outlining to them the signs and symptoms of early opioid tolerance and dependence gives them a powerful tool of self monitoring and awareness. In hand with this includes educating physicians on safe prescribing methods and tendencies; this is also crucial in ensuring a reversal of this problematic trend.
– Outreach and awareness programs in the popular media have begun to trickle down to the patients I see in my practice. I am always appreciative when patients want to have discussions about this with me when contemplating these medications. This provides evidence not only of the savvy knowledge base of patients today, but also of the successful nature of these initiatives.
-The most challenging part in my practice relating to this topic is not these initial encounters or preventive strategies, but rather helping patients that I have identified as having crossed the threshold from pain control to that of addictive behavior. Gratefully, we have several strategies in our armamentarium to help patients such as weaning off offending medications, trial of alternative treatment options, as well as others which are many times effective. Some cases, however, will require referrals to addiction psychiatry and pain management specialists.
Opioid medication abuse is an increasing epidemic that is regrettably having a detrimental yet very preventable effect on many patients and their families. Physicians and health care systems have begun a solid fight with prevention, education, communication, and awareness which have started to make a positive impact and will hopefully continue to do so.