I am sure that nearly everyone reading this knows someone who has died of an opioid or narcotic overdose or knows of a friend or acquaintance or a friend of a friend who has been affected by this problem. Opioid use and illicit drug use have increased in Washington state for the last 20 years. See this reference. In 2017 the Washington state legislature passed one of the nation’s strictest opioid prescribing laws. Since then, narcotic or opioid prescriptions have decreased steadily in the state. Unfortunately, due to rising heroin and methamphetamine use and synthetic opioids like fentanyl, overall deaths from drug use have not fallen, until the pandemic. Drug overdoses took a sharp fall in 2020, probably due to the social isolation everyone experienced due to COVID. They are likely to rise in 2022, but statistics remain to be seen. Synthetic opioids like fentanyl have been wreaking havoc on everyone, especially those under 30; see this reference. You might recall the six US Naval Academy cadets who overdosed on fentanyl inadvertently while on vacation. Some of the victims did not use opioids but came into contact with it by doing CPR on their colleagues.
At Arbor Health, we see the effects of this opioid epidemic in the emergency room, as does every other emergency department. Nearly everyone has heard about Narcan, an opioid-reversing medication that can be sprayed in the nose saving many lives. However, it does not get to the root cause. At Arbor health, we are doing our share to help reduce narcotic use for both acute and long-term opioid use. The state requires all physicians to take a four-hour course on opioid prescribing, which is required for licensure. There are also state guidelines on prescribing; there is a prescription monitoring program known as PMP. This is where physicians or pharmacists can look up the prescriptions of anyone in the state to see what was written, who prescribed it, and where they got it filled. It has helped to reduce illicit use.
Additionally, we have developed a policy and guidelines for our physicians and providers to help them manage their patients who use pain medications. There are many reasons for using opioids; the most common is acute pain from something like a fracture of a bone or acute pain after an operation. Some people have chronic pain syndromes from cancer or severe injuries from accidents.
The general public may not be aware that opioids do not relieve pain; they just make your brain not care about it. Long-term use of opioids also develops something called tachyphylaxis, a fancy term meaning the same drug dose gives you less and less of an effect over time. Subsequently, to get the same response you had at 5 mg, you may require 7.5 or even 10 mg. Over time this results in escalating doses to get the same pain effect, but the risk of harmful side effects rises. This is not good for you or your brain. As I pointed out above, opioids do not actually relieve pain; they just make your brain not care as much about it.
Our goal is to help people remain as highly functional as possible at the lowest amount of medication. Functionality is not dependent on pain perception. One person’s pain is another person’s tickle. You can remain functional while dealing with some degree of pain if you have a chronic pain syndrome. The goal is functionality which essentially means the ability to do the things you would like to do in your life to the best degree possible. Maintaining functionality is what helps your quality of life. As narcotic doses go up, the quality of life generally decreases. You will find the doctors and providers at Arbor Health advising you to reduce your amounts. Some people may be resistant to that, thinking nothing else can help them, but our goal is to help keep you safe, including from unwanted side effects and risks of opioid use.
To help us in the opioid management of our patients you will be asked to sign a pain contract outlining the reasons why you’re using opioids, the dosing, the expectations for you and for us regarding prescriptions and refills. This contract is very serious and helps us keep you from the negative side effects that can come from opioid use. If you are on high doses of opioids you will be asked to begin a tapering schedule down to safer levels of medication. You may sometimes be asked to bring in your pills for a pill count or submit a urine sample for drug testing to ensure the amounts of medications on the prescription are reflected in your body. Depending on your overall dose, you may be asked to come in more often or less often. You may be referred to a pain management specialist who will likely offer you other ways of treating your pain than narcotics. You may be offered physical therapy or lifestyle changes such as improving your diet to achieve weight loss, smoking cessation, and other general health measures that can improve your overall status. We recognize that mental health issues can sometimes impact your chronic pain syndrome and your functionality. There are ways we can try to help you with that, including referrals to behavioral health specialists.
We know that some people have significant ongoing pain from cancer or previous history of severe injuries. Our goal is not to dismiss all opioids but to use them as a tool to help you and not harm you by limiting doses and the length of time used. Opioid use in terminal cancer is not a problem for us or the patient; it is a way to help them in their last moments with their families. Chronic pain is another matter. We want to limit opioid use in non-cancerous, chronic pain and use other means of helping you cope with pain.
Talk to your doctor or primary care provider about these issues. We look forward to serving you and helping you become the best version of yourself.