Government, law enforcement and healthcare professionals are searching for ways to curb rates of opioid misuse and stem the tide of record-high opioid-related deaths.
At Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + the Future of Spine on June 23, three physician leaders discussed the history of the drug crisis and shared methods ASC leaders can implement to reduce the likelihood of addiction and ultimately save lives.
Early in the discussion, Damian Alagia III, MD, chief physician executive and CMO of KentuckyOne Health in Louisville, recounted the history of the physician's role in this drug crisis. Dr. Alagia said The Joint Commission's designation of pain as the fifth vital sign in 2001 spurred the proliferation of opioid pain pills throughout the nation, which played a role in many patients developing opioid use disorder. Many of these opioid users eventually turned to heroin as the illicit drug is cheaper and can be obtained without a prescription, according to Dr. Alagia.
"It all start[ed] with doctors trying to do their best to manage the pain of patients who don't want to be in pain," Dr. Alagia said.
David Rothbart, MD, neurosurgeon and medical director of Spine Team Texas in Southlake, described the challenges of treating patients amide the opioid epidemic and highlighted strategies the practice deploys to reduce the risk of addiction among patients.
"The challenge we have is the primary care doctor sees the patient and gives them narcotics right out of the gate, and then they end up in our office," said Dr. Rothbard. "It's a very challenging situation when a patient comes in on narcotics, and then we're trying to change that and take them off of narcotics."
To reduce the risk of addiction, Spine Team Texas increased care access for patients in severe pain, oftentimes seeing them the same day they've been referred by a physician.
"Our message to our referring physicians is to not worry about prescribing medications and to get them in to see us," Dr. Rothbard said.
Additionally, Spine Team Texas has multiple protocols in place to screen patients for psychological illness and opioid addiction, and a very stringent urine drug screening program.
Michael Redler, MD, partner at Orthopedic and Sports Medicine Center in Stratford, Conn., discussed the importance of addressing patient expectations of pain. Dr. Redler recommended the adoption of a tactic used at his practice, which involves revamping the traditional scale used to assess patient pain. Where the traditional scale asks patients to rank pain severity on a 10-point scale — 10 representing the highest level of pain — Dr. Redler suggests framing the assessment as a comfort scale. Asking patients to report their comfort level can alter their expectations of post-surgical pain management, according to Dr. Redler.
At the Sports Medicine Center, clinicians also emphasize reducing the amount of pain pills prescribed. To facilitate such a reduction, physicians regularly use regional anesthesia and prescribe multimodal pain management regimens after a procedure, including the routine use of Tylenol and anti-inflammatory medications during recovery. Additionally, patients are given just a small amount of opioid pain pills — typically less than a week's supply — and told to use the pills only for breakthrough pain.
Dr. Redler's comments also highlighted the ubiquity of the issue and the need for healthcare providers to step into a leadership role to address the problem.
"Everybody knows someone [who's been affected by this]," said Dr. Redler. "It does not miss any family and it does not miss any socioeconomic class. And as healthcare providers and healthcare administrators, we need to be a clarifying voice in dealing with this issue."
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