The recent spike in overdoses of fentanyl, a potent synthetic narcotic, in Sacramento has put an even brighter spotlight on the opioid epidemic and the need to battle this issue on many fronts.
In Sacramento we’ve seen 52 opioid overdoses since March, with 12 of those cases resulting in deaths. These tragic overdoses in the region unfortunately are not unique. It happens on the ground in many communities, and we know that it happens to high-profile celebrities. This is an epidemic that knows no geographic or socioeconomic barriers.
The factors behind the opioid epidemic are numerous, but there is misunderstanding about the impact of physician prescribing – or overprescribing – practices.
Certainly, that may be a contributing factor with certain physicians lacking the knowledge to carefully assess risk among patients and prescribe accordingly. But painting all physicians with the same brush is not helpful, and focusing on this element alone may harm patients who require medication for pain relief.
Historical perspective is helpful. About a decade ago, many medical societies and governmental agencies posited that pain should be treated as the “fifth vital sign,” joining temperature, heart rate, blood pressure and respiratory as key gauges of patient health and stability. Therefore, monitoring pain scores became a primary focus of physicians in order to be responsive to patient satisfaction surveys that queried whether physicians did everything possible to treat pain.
Hospitals and physicians felt pressure to treat pain more aggressively, with higher doses and larger prescriptions, while patients increasingly had unrealistic expectations that they should never have pain. As a result, the use of prescription painkillers skyrocketed, and prescription opioid abuse blossomed into a national problem.
Now our current efforts to combat opioid misuse have at times evolved into a war on prescription pain medication use. That’s unfortunate, because more than 100 million Americans live in chronic pain. For this subset of patients, clinicians must carefully balance access to necessary medications with controls to minimize the potential for abuse.
Pain specialists, a subspecialty of anesthesiology, are best equipped to make this assessment. On a daily basis, we assess patients, determine whether they are the right candidate for opioids, implement other pain-management approaches, and carefully monitor and manage pain therapy. Policymakers would be wise to consider our unique expertise in developing strategies to fight the epidemic of opioid misuse.
We spend years learning pharmacology and physiology to understand who will respond well to opioids and at what level. And we recognize our role in educating patients about the medications, their interactions, signs of overdose and proper disposal of unused medications.
We rely on impartial tools like random drug screening, and state prescription drug monitoring databases for evidence of abuse. And above all, pain specialists constantly pursue other multimodal options for treating pain that allow patients to get back to life and back to work without opioids.
The best medical policy in the war on misuse will parallel these best practices, holding patients that are abusing opioids accountable, while avoiding classification of those in chronic pain as drug addicts.
While there is more to be done, the guidance of pain specialists with these important initiatives can help to cut the number of overdoses and deaths among the American public.
Dr. Shalini Shah is chair of the Pain Task Force for the California Society of Anesthesiologists and assistant clinical professor and director, pediatric pain services at the Department of Anesthesiology & Perioperative Care at the University of California, Irvine. Contact her at firstname.lastname@example.org.