There is a lot of talk about opioids in the news these days, with recurring, unfortunate reports about opioid-related overdoses and deaths. The issue is frequently labeled a “crisis” or “epidemic” in some parts of the United States, and for good reason: between 1999 – 2017, more than 200,000 Americans died as a result of a prescription opioid overdose.
Privia Medical Group North Texas physicians are committed to their patients’ health and safety first and foremost and view the proper prescribing of medication, especially opioids, as essential to protecting patient safety.
“At Privia Medical Group North Texas, our physicians will carefully evaluate all options for treating pain and will only prescribe an opioid if we believe it is the most effective way to treat the patient and the risk of a harmful side effect is acceptably low,” explains Dr. Thomas Ratino, a pain management specialist. “Opioids are never the first option we start with, and if we do prescribe an opioid, we will discuss it thoroughly with the patient first. This approach, combined with the implementation of new reforms regulating opioids in Texas, will further protect patient safety.”
Patient safety starts with everyone having the facts on this important topic. What are opioids? When are they used? How are they misused? How is it they can be so dangerous? Are there alternatives to opioids? And how are health care providers working to protect their patients?
What are Opioids?
Opioids are a class of powerful drugs that are used to relieve pain. They are sometimes used to treat moderate to severe pain resulting from an injury, surgery or cancer. Some common prescription opioids include oxycodone, hydrocodone, morphine and methadone. Not all opioids are prescription drugs, however. For example, heroin – an illegal drug – is also considered an opioid. Fentanyl is a very powerful, synthetic opioid that is sometimes prescribed for severe pain but is also manufactured illegally and sold on the black market.
Sometimes, opioids have a useful role to play in pain management. For patients battling cancer, an opioid may be necessary to make the pain manageable. In the wake of a severe injury or surgery that is causing acute pain, an opioid prescription for a limited amount of time may be the most appropriate treatment.
In recent years, opioids have been prescribed at times to treat chronic pain, such as osteoarthritis or back pain. This has, in part, contributed to the rise in some people becoming addicted to opioids.
Because they are highly addictive, opioids are dangerous to take for an extended length of time. When people take opioids on a long-term basis, a resistance to the drug may develop. This resistance can lead to the urge to take even more of the opioid to feel a meaningful effect, creating a dangerous cycle that may lead to an overdose. An opioid overdose can kill by causing the person to stop breathing.
Combatting the Problem
According to the U.S. Centers for Disease Control and Prevention (CDC), an average of 130 people lose their lives every day in the United States as a result of an opioid overdose. Texas Department of State Health Services data show that in 2015, the most recent year for which the agency has public information available, 1,174 Texans died in an “accidental poisoning death where opioids were involved.” Commonly prescribed opioids and heroin accounted for almost exactly the same number of deaths, at just over 500 each. Synthetic opioids, other than methadone, led to 153 deaths. There were deaths in all age categories, ranging from 15-24 up to 65-74. The 25-34 age group had the most deaths.
Given these numbers, opioid abuse is clearly a problem across the United States, including in Texas. That’s why the medical community, law enforcement and government are working together to reduce the dangers posed by opioids and ensure they are used only when necessary and appropriate to treat a medical condition.
To better protect public health, a number of new reforms have been passed in Texas over the last few years, including:
- Beginning in September of 2019, opioid prescriptions for acute pain are limited to a maximum of 10 days with no refills
- Beginning in March of 2020, prescribers must check a patient’s prescription history in the Prescription Monitoring Program (PMP) database. Texas pharmacies are already required to use this database to record all controlled substance prescriptions they have filled. The CDC describes these databases as “among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.”
- Beginning in January of 2021, all controlled substances may only be e-prescribed; i.e., no written prescriptions
- Requiring prescribers to complete additional continuing education related to controlled substances
“These reforms are important tools for prescribers to better protect the health of patients,” explains Dr. Vinay Dalal, a pain management specialist. “With a 10-day/no-refill limitation on acute pain prescriptions, we’re dramatically reducing the likelihood of addiction taking hold. And the PMP database will help us detect if a patient is trying to get multiple prescriptions filled through different prescribers in a short amount of time – that’s a key indicator of addiction and overdose risk. We want to identify those patients, help them break that cycle of addiction and get well.”
Another recent change in Texas law is aimed at expanding access to naloxone, a medication that can reverse the impact of an opioid overdose, but only if administered quickly. Efforts are underway to make naloxone more readily available to first responders, school personnel and others in the event they encounter a person showing signs of an overdose.
It’s important to remember that opioids are not the only option to treat pain. Physicians have a wide array of treatment options to help their patients. PMGNTX pain management physicians help patients with all different types of pain, and opioids are but one of several pain-relief treatments available.
A pain management specialist can carefully evaluate medication options, balancing the efficacy of combating pain with any potential side effects. For example, some over-the-counter medications can be effective at alleviating muscle aches and back pain, but prolonged use can have negative side effects on the digestive system.
There are a variety of other strategies a pain management specialist may use to help manage pain. Sometimes, steroid injections into the area of the body where the pain originates can help reduce inflammation and pain. Injection of a local anesthetic can help to numb the pain for a period of time.
In other cases, a physician can block the peripheral nerves responsible for the feeling of pain. Radiofrequency ablation is a minimally invasive procedure that will destroy the nerves causing the pain. Spinal cord stimulation is a procedure that can help mitigate lower back pain.
Some treatments don’t mask the pain but help the patient to better manage it. Cognitive behavioral therapy is a program that helps the patient understand how he or she reacts to pain and helps refocus their thoughts and energies to overcome the pain and stop it from interfering with every aspect of their lives.
Physical and occupational therapy is often an important part of a pain management treatment plan, depending on the cause of the illness or injury. Particularly for someone with an orthopedic injury, getting stronger and learning how to move in a way that does not exacerbate the pain is essential. The same is true for patients recovering from hip surgery, stroke and other illnesses.
Combatting Pain While Protecting Patients
PMGNTX physicians are committed to helping their patients control serious pain, whether it is acute or chronic, while also safeguarding against potentially dangerous side effects from the treatment. When it comes to opioids, physicians use special care in this regard.
“We are committed to helping our patients who are experiencing pain,” says Dr. Timothy Ratino, a pain management specialist. “In addition to trying to address the underlying cause of the pain, we have a variety of options to tackle the pain itself and we will always be very mindful of potential side effects of any treatment, especially powerful opioids.”
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