Too often in recent years, you hear story after story about people dying from overdoses of opioid painkillers, such as oxycodone or fentanyl. Celebrities, the guy next door, and even teenagers are abusing these drugs, which are often prescribed by doctors with the best of intentions. How can physicians and other clinicians reverse the trend of addiction, misuse, diversion and overdose deaths while still treating patients’ legitimate pain?
Although many people believe that prescription drug abusers get them from a friend or relative, the people at highest risk of overdose actually get them from a doctor’s prescription.
First, use your state’s prescription drug monitoring program (PDMP) to identify patients who might have misused prescription drugs in the past and are at risk of abuse or overdose. In other words, look before you prescribe.
Overall, be sure to discuss safe, effective pain management with your patients. Cover topics that will hopefully reduce their risk of misuse, abuse or overdose, such as:
- the risks of taking prescription painkillers, including addiction, overdose and death
- alternative pain treatment options, such as over-the-counter pain relievers or physical therapy and exercise
If you determine that your patient does need prescription medication, be sure to follow best practices for responsible painkiller prescribing, which include:
- establishing ground rules for the use of painkillers, such as how long you will prescribe them and what other treatment options the patient might pursue
- prescribing the lowest effective dose and the smallest quantity needed for a reasonable, expected duration of pain
- teaching your patients what they need to know to stop taking the opioids when their treatment is done
- sharing information on how to use, store, and dispose of opioids
- being careful to avoid combining prescriptions for opioids and sedatives unless there is a specific medical indication to do so
Be scrupulous about checking a patient’s progress and pain levels before refilling a prescription for opioids. If they are not reporting increased function and reduced pain in a reasonable amount of time, see that as a red flag and discuss the patient’s situation thoroughly.
If you suspect a patient is abusing or sharing prescription drugs and are in the Western New York area you can refer them to the Painkillers Kill 24/7 HOPE line at855-969-HOPE or call Horizon Health Services at 716-831-1800.