By Debra Beaulieu-Volk, Vital Signs Staff Writer
Speakers at Friday’s Opioid Misuse and Addiction Summit at MMS Headquarters each brought varied backgrounds and expertise, but they all had one mission in common: to talk strategy about how to effectively aid patients suffering from addiction and prevent new dependencies from forming.
All experts, including keynote speaker U.S. Attorney Loretta Lynch, emphasized the importance of a collaborative, multi-faceted approach to conquering the chronic disease of addiction. A secondary theme that emerged surrounded the notion of time.
Physicians are not widely reimbursed for spending extra time talking with or on behalf of patients, panelists noted. But with the devastating magnitude of opioid addiction and drug-related deaths, the stakes are too high not to invest more in certain critical moments.
Change the “quick fix” culture
One place to start, experts agreed, is in reducing the amount of prescription opioid medication in our environment. Many who misuse these pills obtain them not from doctors, but from friends and family members, with and without their knowledge, noted Wilson Compton, MD, MPE, Deputy Director of the National Institute on Drug Abuse. These pills would be harder to access if doctors prescribed them less often and in smaller amounts when they do, and if patients were better educated about how to store and dispose of unused medications safely. View Dr. Compton’s slides. (.pdf, 11 pages)
Curbing painkiller prescriptions will require a change in the United States’ current “quick fix culture,” said Maura Healey, Massachusetts Attorney General, noting that prescribing of opioids has grown exponentially in the last 15 to 20 years.
Pressed for time, it has become normalized for physicians to reach for a prescription pad rather than exploring alternative treatments to chronic pain. Thus dynamic must change, experts urged, with special attention paid to patients identified as high-risk for dependence.
Take advantage of the PDMP
Law enforcement officials pointed to the utility of the state’s prescription drug monitoring program (PDMP) as a tool to identify and thwart doctor-shopping. “The tool is right there. PDMP is a great opportunity to hit that one little button and find out what else has been prescribed,” said George Zachos, Chief of Medicaid Fraud Unit and Massachusetts Assistant Attorney General. “If the physicians and pharmacists are using [the PDMP] properly, it should never get to us.”
Identifying a potential case of addiction, diversion, inappropriate prescribing, or other misuse is, as with all elements discussed, just a piece of the puzzle. Most physicians and pharmacists don’t currently have the tools to take the next step and have difficult conversations with patients, panelists noted.
Engage and educate patients
But the common practices of firing the patient or simply refusing to prescribe perpetuate the problem, not just failing to address underlying addictions but upping the chances patients will turn to heroin to self-medicate. Rather, experts advise using the opportunity to engage patients and offer or refer treatment for substance disorders as soon as possible.
When patients aren’t motivated to get help for addiction, physicians should communicate similarly to how they would with someone not managing his or her diabetes, said Sarah Wakeman, MD, leader of an initiative to address opioid addiction at Massachusetts General Hospital. “Often people are ambivalent. It’s our job to tip those motivational scales,” she said. “There are opportunities when people very much do want help, which is why having help immediately available is so important.”
There are times, of course, when the benefits of opioid treatment outweigh the risks, and a prescription is helpful and appropriate for the patient. But many, if not most, devastating addictions begin with a legitimate short-term prescription, experts noted. Therefore, physicians and pharmacists should be sure not to miss this critical opportunity to educate patients, according to Nancy Coffey of the U.S. Drug Enforcement Administration. She told physicians and pharmacists: “Take the extra 10 seconds to advise patients, ‘This is powerful. Treat it that way. Put it where no one will have access.”