May 31, 2016
As the use of prescription pain-killing opioids, and problems associated with their use, has increased, clinicians now have the difficult task of balancing patient pain relief with the need to prevent adverse outcomes. That was the theme of an opioid prescribing training session for clinicians held May 12 at The University of Alabama. The session by the UA Substance Abuse and Health Services Administration, “Clinical Challenges in Opioid Management: Balancing Safety and Efficacy,” was conducted by two physicians selected by SAMSHA, Drs. Jacqueline Tulsky and Stephen Wyatt. The session was hosted by UA’s College of Community Health Sciences, Capstone College of Nursing and School of Social Work. “The course will address the balance between providing pain relief and preventing inappropriate use of opioids,” Tulsky said as she welcomed the more than 100 physicians, nurses, social workers, medical students and resident physicians to the training session. “This is as much of an art as a science.” Tulsky is emeritus professor of Medicine at the University of California, San Francisco, in the HIV/AIDS Division at San Francisco General Hospital. Wyatt is medical director of Addiction Medicine/Behavioral Health Service Line at Carolinas HealthCare System in Charlotte, North Carolina. According to SAMSHA, chronic pain affects about 100 million Americans, approximately one-third of the population. The agency said pain is the most common reason for medical visits, and there are 40 million pain-related doctor visits each year. An estimated five million to eight million individuals are on opioids long term, and the number of opioid prescriptions written for pain treatment grew from 76 million in 1991 to 219 million in 2011, according to SAMSHA. “The prevalence of chronic pain and the increasing use of opioids have created a silent epidemic of distress, disability and danger,” Tulsky said. Efforts are underway nationwide to stem opioid abuse. Unintentional overdose deaths from prescription painkillers nearly quadrupled from 1999 to 2013, according to the US Department of Health and Human Services. During the training course, information was provided about preventing adverse patient outcomes by teaching clinicians how to identify candidates for opioid therapy, how to monitor patient responses and how to better recognize problematic behaviors. Opioids are effective in providing relief from pain, but there are side effects – nausea and vomiting, constipation, insomnia, respiratory depression, cognitive impairment and psychomotor dysfunction, and in rare cases organ toxicity. There’s also misuse, overuse and abuse of opioids, and even overdose deaths when opioids are combined with other medications or sedatives, Tulsky said. A relatively new, unintended consequence has emerged – the shift from opioids to heroin. As access to opioids has tightened, more people are turning to heroin for pain relief and death rates from heroin use are increasing, Tulsky said. “There has been a rise in heroin use since 1999. Heroin is cheap and easy to get. No one will take care of you like your dealer will.” Tulsky and Wyatt said the goal for clinicians is to “have a reasonable balance” and to “give opioids with some counseling to make it safer.” “Pain is a complex problem, it’s not a single item,” Wyatt said. “As health care providers, we need to listen to patient experiences. Pay attention to depression, anxiety and other things they are experiencing. If we listen to patents we can start to care for them more effectively.”
