Observations on fight against opioid problem
We must find alternative pathways to pain control. Even with more limitations and restrictions placed on opioid use, there is more that we can do for our patients.
In October, President Trump declared the opioid crisis a public health emergency. More recently, state governments have pursued additional legislation that will directly affect physicians and patients.
Having practiced medicine for 32 years, I have seen how doctors became accustomed to prescribing these medications and understand why medicine is one of the most regulated industries in the United States. As physicians, we must take responsibility for our actions. However, laws are still necessary to curb these habits for good.
With 34 active state licenses, I would need a much longer piece to comment on pending or enacted laws in all of them. Florida, for example, recently passed legislation that, like most states, limits the quantity of opioids that can be prescribed by a physician, provides additional funding for treatment programs and requires physicians to check the state’s prescription database.
On the surface this appears more prudent, but it’s important to see the full picture. As physicians and patients prepare for these changes, here are three important observations to keep in mind moving forward:
• We can’t use a “cookie cutter” approach. Medicine has never been, and should never be, approached with a “cookie cutter” mentality. Physicians have and should continue to provide the best care to their patients based on their experience, knowledge and training.
The Florida legislation includes language allowing exceptions to the threeday rule for some patients with acute pain. This is critical. It’s important to take into consideration patients with extensive trauma, terminal disease and those who are post-surgery. However, opioids can only be refilled with a paper prescription necessitating increased doctor visits. This presents problems for those with limited means of transportation or finances.
• We must find alternative pathways to pain control. Even with more limitations and restrictions placed on opioid use, there is more that we can do for our patients. At Laser Spine Institute, we have initiated our own approach, using a combination of different non-opioid medications that act on different areas of the patients’ pain pathways, such as a combination of Tylenol, Lyrica and Celebrex (TLC), Exparel, Tramadol and other non-opioid modalities. When combined, these medications impact pain more effectively than if used independently.
When an opioid is deemed absolutely necessary, we start with the lowest potency at the lowest dosage needed for pain control. Our goal is to significantly reduce — if not eliminate — the use of opioids altogether.
• Our future is in research. Initially marketed as safe and effective for pain control, opioids have warped into the present-day crisis. I believe the future is in research to help us better understand pain pathways and specifically, how to treat pain without the devastating side effects of opioids. Federal and state government officials have acted to help rectify this situation and, as a physician, I applaud their efforts.
I welcome further changes as I partner with my peers to improve our present process of treating pain. It’s a journey that has made progress — but there’s still a long road ahead.