A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all too familiar.
Every year in September we acknowledge people struggling with pain during National Pain Awareness Month. It’s an important month dedicated to the roughly 100 million people suffering from chronic pain in the U.S. It’s also important to acknowledge that the abuse of prescription medication is a serious epidemic that has developed in recent years in the U.S.
When used appropriately and under the supervision of a physician, prescription medicine can relieve pain and even save lives. But when abused, it can take a tragic toll on families and communities. A variety of prescribed medications are abused, but most overdoses from prescription drugs are caused by opioids, a type of pain reliever. Oftentimes, people who misuse opioids were not prescribed the medication, but obtained it from someone else.
As a physician anesthesiologist and pain medicine specialist, I strive to treat all my patients with care individualized to their needs. If pain medicine is a part of the treatment plan, it must be prescribed with caution. Pain is a subjective experience. At this stage in the study of pain medicine, we cannot know for sure what level of pain the patient is experiencing. Objective tests for pain intensity and even the presence or absence of pain are still in the beginning stages of research. We must rely on self-reports from patients and, because of this, pain assessment must be catered to the individual.
There are a number of precautions we can take as providers to assess and treat pain appropriately. When opioids are being considered for patients with chronic pain, risks should be evaluated before prescribing medication. We can accomplish this by using our judgment and skills developed from experience and years of education and training. Clinical tools, such as checklists and patient questionnaires, also play a role in helping to screen patients who may be at risk for abuse of opioids.
It’s crucial for all parties involved — providers, pharmacists, patients, family members and patient advocates — to be aware of warning signs for prescription medication abuse. Some of the red flag behaviors include:
- Patients travel to a physician’s office as a group and request prescriptions on the same day.
- A patient visits the doctor but declines a physical exam, does not give permission to obtain past medical records, or refuses to undergo diagnostic tests.
- A patient shows physical or behavioral signs of drug abuse.
- A patient refuses to sign an opioid pain care agreement.
These are just a few warning signs that we as physicians need to watch for when deciding whether or not opioid medication is appropriate for a patient.
While we strive to prevent opioid abuse, patients and their loved ones should also be familiar with the physical signs and symptoms of abuse, such as slow breath, depression and poor coordination. In addition, adults must be responsible for properly and safely storing and disposing of any unused or expired medication at home.
While opioid abuse poses significant challenges in today’s society, players in health care are working toward providing the appropriate education to the medical community and to the general public, as well as strengthening programs that will hopefully lead to decreased abuse.
Asokumar Buvanendran is an anesthesiologist.
