Nonopioid therapy should be the first line for treating pain whether for chronic or other types of pain.
When a patient fails nonopioid treatment, then escalating up to the opioids should only be when the benefits outweigh the risks. Providers should have an agreed upon treatment plan with the patient. The lowest dosage should be considered when starting on any type of pain medication. According to the article in JAMA, 2016, the authors, Dowell, Haegerich and Chou state that primary care clinicians find managing chronic pain challenging.
Surgeons after surgery find it difficult to manage surgical pain after a patient has been on a high dose of opioids. This is especially true when the patients are not forthright in the dosage and or medication prescribed. The January 1, 2016 Morbidity and Mortality Weekly Report, Rudd, Aleshire, Zibbell and Gladden detail the increases of overdose opioid deaths in the United States from 2000 to 2014. And, the deaths are described as an epidemic. The skin color, gender, race nor location was a factor for the increase in these deaths.
However, in the middle of the years 2013 and 2014, there was a drastic rise in the death toll. The authors reported in 2014,The deaths coincided with law enforcement reports of increase availability of illicitly manufactured fentanyl, a synthetic opioid; however, illicitly manufactured fentanyl cannot be distinguished from prescription fentanyl in death certificate data. These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence and death, improve treatment capacity for opioid use disorders and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl. (Rudd, et al. , 2016, p.
1). Consequently, this leads into the area of prescription pain medication overuse or misuse. The authors maintained that not using the opioid pain medications as the intended purpose can open the door for heroin use. Heroin is cheap, untainted and accessible. Both of these types of drug overdoses whether prescription or heroin are on the rise and the partnerships between healthcare systems and communities will need to improve for the health of the community. According to the authors of the July, 2016 Health Affairs, the majority of the United States have drug monitoring programs.
The two states that do not participate in this program are Missouri and New Hampshire. These programs collect information from pharmacies and report the analyzed information to physicians. The objective is to reduce the amount of doctor shopping. When comparing the two articles, as the overdose drug opioid deaths increased in 2014, the amount of drug monitoring programs increased. With this retrospective study, the authors reviewed the data and reported that the implementation of the programs increased while the drug overdosed deaths decreased.
Florida worked with the federal government and took action and closed a pill mill operation. With this action, Florida saw a decrease in opioid-related overdose deaths (Patrick, et al. , 2016, p. 2). In summary, as the CDC saw the opioid-related deaths as an epidemic from 2000 to 2014, the states saw a need in reducing deaths.
At the state level, a drug monitoring program provided pharmacies to work with the provider and send notifications of patient’s prescriptions, thus eliminating doctor shopping and pill mills. This type of program is an example of how partnerships between healthcare systems and communities improved for the health of the community. At our facility, when the state of Texas and the DEA ruled that hydrocodone must be prescribed by a physician, this impacted the transplant surgeons and the practice changed. Tylenol with codeine and tramadol is now prescribed with a maximum quantity of 30 and no refills. Patients that require hydrocodone must have a face to face physician communication and discussion. The prescribing physician will write for the lowest amount and lowest quantity.
Patients that require a high dose of pain medication after transplant surgery will be referred to pain management. Our facility has experience pharmacies calling to notify the provider of pain medications that are too soon to fill. How do you see your facility handling narcotics? Is there a protocol in place? What have you experienced?ReferencesDowen, D. , Haegerich, T. , Chou, R.
(2016) CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. JAMA. 315(15): 1624-1645. doi: 10. 1001/jama. 2016.
1464Patrick, S. W. , Fry, C. E. , Jones, T. F.
, & Buntin, M. B. (2016). Implementation of Prescription Drug Monitoring Programs Associated with Reductions in Opioid-Related Death Rates. Health Affairs. Advance online publication.
doi: 10. 1377/htlthaff. 2015. 1496Rudd, Rose A. , Aleshire, N. , Zibbell, J.
E. , & Gladden, R. M. (2016).
Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014. Morbidity and Mortality Weekly Report (MMWR), 64(50), 1378-82.
