Morning Rounds: Doctors Look for Solutions as Evidence of Opioid Long-Term Ineffectiveness for Chronic Pain Mounts
To Your Health —
Thursday, June 16, 2016 2:06 PM
Dr. Alan Barker has begun to work with his patients who take narcotic medications for chronic pain to find better and safer ways to manage that pain.
Mark Fourre, MD, is an emergency physician and Chief Medical Officer of LincolnHealth. He also serves on their Board of Trustees. Prior to joining Lincoln- Health, Dr. Fourre was an attending faculty physician at Maine Medical Center where he developed the Emergency Medicine Residency Program and served as Residency Director.
Patients who have been diagnosed with cancer or are at the end of life may still require opioids for chronic pain, but other patients may do better with help from pain specialists who will work with them on alternative ways to control pain, including anything from increased use of alternative medications to meditation or acupuncture.
A physician at the Lincoln Medical Partners Family Care Center in Boothbay Harbor, Dr. Barker has been a family practitioner for 25 years. He makes house calls and stays late at the office to catch up on paperwork because he spends every minute possible during appointments in direct communication with patients.
What he is doing will affect the lives of many of his patients who suffer from real chronic pain. His own experience as a physician and a growing body of research have convinced him that, when used for long periods of time, opioids are not only ineffective; they can actually make pain worse.
So far, patients who have successfully stopped using narcotic medications agree.
One patient, who formerly used opioids every day, is now using his prescription on an as-needed basis. He told Dr. Barker he feels better than he has in years. The fog that accompanied opiate use has cleared away, he says.
Another patient recently told Dr. Barker that after weaning himself off the drugs, he never wants to go back. Not only did opioids not solve his pain problem, they made his life worse.
“Worse” can mean different things for different people, but for nearly every patient who uses opioids for long periods of time, it means increasing dependency as their body develops tolerance to the drugs and an increasing sensitivity to pain.
Nationwide, some patients who received opioids for chronic pain began using illegal narcotics such as heroin. According to the U.S. Centers for Disease Control and Prevention, people who are addicted to opioid painkillers are much more likely to become addicted to heroin.
In Maine, as in many other states, the shift from prescription opioids to illegal narcotics has created a crisis. There were 272 drug overdose deaths in Maine last year, a new high. For comparison’s sake, 155 people were killed on Maine roads that same year.
And while opioids can cause great harm, they neither extend life nor save lives. Side effects include constipation and depression, and patients are also at risk of being victimized by addicts who target people with legitimate prescriptions.
In short, opioids are extremely effective in relieving pain over the short term, but as patients use them for longer periods of time, they become a trap.
How did we get here? The answer, as with so many things in life, is with the very best of intentions.
In the early 1990s, with the advent of powerful new opioid pain medications like oxycodone, physicians were encouraged to think of pain as a vital sign. The goal was for every patient to be pain free.
What we didn’t understand was how long-term use of these drugs would change patients’ brains.
Today, the medical community is just beginning to understand the neurology of opioid addiction as it deals with the aftermath of that misguided policy.
As rules and regulations surrounding the use of opioids have proliferated, refilling prescriptions and monitoring people who are using opioids has become increasingly time intensive.
Currently, prescriptions have to be written by hand and cannot be faxed or called in to pharmacies. At Lincoln Medical Partner practices, opioid prescriptions also have to be checked against a statewide database to make sure the patient does not have multiple prescriptions for the same type of drugs. Patients may also have to submit to urine tests or spot pill checks to ensure they aren’t selling their medications.
If a patient’s prescription is not renewed for any reason, they often become extremely upset.
What it comes down to for Dr. Barker is that opioids aren’t working and they are distorting the trusting relationship he has built over the past decades with his patients.
But that still leaves one question: How do you provide long-lasting pain relief without harming the patient?
There may not be a single answer to that question, at least not the kind that comes in the form of a pill.
What is clear to Dr. Barker is that opioids are not the answer and it is also clear to him that his first responsibility as a physician is to do no harm.
While he does not have a one-size-fits-all answer for chronic pain, he is committed to working with each patient to find what works best for them. That kind of doctor-patient relationship is a solution that works for many of his patients, and it may also be one of the best answers we have to the opioid crisis.