Colo. health care provider tames pain with non-pill treatments
lafayette» Over the roughly two decades Lynell Reed was prescribed opioids in increasing potency to cope with pain from an injury she suffered in a car crash, the electrical engineer and sales executive tried several times to come off the powerful drugs.
But during each attempt to quit her medications — ranging from morphine to methadone to fentanyl, which is considered 50 times more powerful than heroin — Reed agonized for months from the effects of withdrawal.
Then her health care provider recommended she join a new Kaiser Permanente clinic aimed at helping patients better manage their pain and come off potent drugs. At 64, she has been opioid-free since June.
“I feel like a different person,” Reed said. “The clinic totally turned my life around.”
Since January 2015, Kaiser has been running what it calls a one-of-a-kind integrated pain-service class aimed at helping its highrisk opioid patients better manage their pain through alternative treatments and understand the risks of the drugs. The idea is to show patients they don’t necessarily need a pain pill to manage their pain.
With Colorado and the nation in the grips of a prescription painkiller epidemic — which has been blamed for a resurgence of heroin and skyrocketing overdose deaths — those running the program hope it can be a way to stem the rising tide and prevent overdoses and addiction.
Opioid-linked deaths in Colorado have risen sharply over the past 17 years, from 73 in 1999 to 329 in 2015, according to Colorado Department of Public Health and Environment data. The state also ranks among the highest in prescription drug abuse.
So far, more than 200 patients have enrolled in the eight-week initiative, which is staffed by 15 health care providers — ranging from psychologists to pharmacy specialists — and based out of Kaiser’s Rock Creek campus in Lafayette.
The class teaches participants about options outside of a pill to manage their pain, from deep-breathing to changes in their diet. The sessions also teach how opioids react with other medications. At a recent session, about a dozen people listened to a physician talk about the benefits of acupuncture with a few of them getting pricked to see how it works.
“We’ve become aware that there is a national epidemic of opioid prescribing and it not being as effective as we thought it was going to be,” said Amanda Bye, a clinical psychologist who helps run the service. “The industry thought that prescribing opioids was going to be relatively safe given that we were prescribing it for cancer patients who were at the end of their lives. Decades later, we know different things now. We know that long-term use has a higher risk than we thought it was going to have with a lower benefit.”
Kaiser has been very aggressive in addressing opioid prescribing, launching a review of all of its opioid patients and committing to reducing the volume of the drugs being diverted into communities.
One of the ideas stressed in the clinic is that opioids are not painkillers. They are pain managers.
“Best care is not just medication,” Bye said. “We know that using opioids alone aren’t that effective for managing chronic pain. Opioids alone are about 30 percent effective, at best, for helping manage chronic pain. We know that cognitive behavior skills — such as deep breathing, mindfulness, relaxation — are about 50 to 60 percent effective.”
Those referred to the integrated pain service are considered high-risk because of factors including the high dose of opioids they are being prescribed or a history of drug abuse or misuse.
Three other satellite programs in the Denver-Boulder area offer the service to patients with lower risk for negative outcomes.
“I think to get a program like this is pretty special,” said Will Gersch, a clinical pharmacy specialist in pain management who works in the service. “Patients that don’t take advantage of this resource, they don’t have the same knowledge of the risks.”
Gersch said some patients are sometimes reluctant to abandon or reduce their use of opioids out of fears of withdrawal and pain flares.
“They feel like that medication is the only thing taking their pain away,” Gersch said. “So when you’re taking that one thing away they feel like will manage their pain, that’s a little scary. But giving them other options, that reduces a lot of that fear.”
Robert Valuck, director of the Colorado Consortium for Prescription Drug Abuse Prevention, says he doesn’t know of another program in Colorado quite like Kaiser’s. Some similar initiatives will have pieces of the integrated pain service — such as behavioral counseling or group sessions — but not all together.
“I think it has that potential,” said Valuck, who teaches drug safety at the University of Colorado’s Anschutz Medical Campus. “The most studied examples of this kind of integrated pain management date back to the 1970s. The hard thing is how do you scale that thing. If there are 500,000 people a month in Colorado getting an opioid prescription, how can you get them all in that class?”
Valuck says most people who become opioid abusers are not chronic pain patients. About 70 percent started with something they got from someone else’s medicine cabinet. The hope, he says, with programs such as Kaiser’s is that the education elements will trickle out.
“So often, (when) individuals get a prescription, they don’t necessarily ask the right questions relative to how to take it with other medications,” said Suzi Stolte, co-chair of the JP Prescription Drug Awareness Foundation.
Stolte’s daughter, Heidi, died of mixed drug toxicity in 2011 after she was prescribed opioids for a back injury.
“I think people so often think, ‘Oh, I can take this painkiller and go from a nine or a 10 on the pain scale to a zero or 1,’” Stolte said. “That’s not what happens. You don’t have that kind of swing.”