Minnesota Researching Opioid Alternatives

opioid abuse alternativesEven if you’re not a chronic pain sufferer, you’ve probably heard about the “opioid crisis” here in America. Overdoses and accidental deaths from pain medications have skyrocketed in recent years, and things are only getting more divisive as we try to put an end to overdoses. There are too many competing interests working against one another. For example:

  • You have a government officials who are supported by money from big pharma.
  • You have big pharma, who is making a lot of money through the increase in prescription medications.
  • You have some overworked doctors who jump right to pain pills instead of taking more time to find solutions.
  • You have some chronic pain patients who take the idea of opioid regulation as a personal offense.

That’s simply too many interests pulling in too many directions, and chronic pain patients are suffering because of it. However, Minnesota has recently taken some tangible steps to look for alternatives to opioids.

Opioid Alternatives

Earlier this month, leading medical minds met in St. Paul to talk about some alternatives to pain management to help combat the opioid epidemic. They discussed a range of possibilities, including such options as:

  • Electrotherapy
  • Radio-frequency ablation
  • Cryogenics
  • Implantable spinal cord stimulators
  • Epidural injections
  • Medical gadgetry
  • Chemical compisitions
  • Physical therapy techniques

The goal of the meeting was to help lawmakers understand that they have the ability to influence how research funding can be allocated for some of these alternatives, and that the future of these pain management techniques are worth exploring.

Dr. Clarence Shannon, an anesthesiologist who works in the University of Minnesota Pain Clinic in Minneapolis, spoke about the summit and how it’s important to test out potential treatment options before jumping to opioids.

“It’s a stair-step approach that I like to use: nonsteroidals, anti-epileptics or neuropathic medications. We’ll try radio-frequency ablation if we can. We’ll do nerve blocks. And then we’ll move up to the things like the implantable devices,” Shannon said.

These alternatives aren’t perfect solutions, and while they do have some drawbacks, the downsides are much less threatening to a patient’s health than the negative consequences of opioids. Medical devices may cost more, may be more prone to malfunction and may require battery changes, but those downsides are worth it if they can protect us against opioid abuse and overdose.

A Good Start

The pain management summit was a good start, but we need to also focus on getting everybody on the same page. We need to the government to look at the bottom line in terms of lives saved and not dollars earned. We need to take the burden off doctors so they don’t feel the need to fall back on opioid prescriptions without first exhausting some other options. We need chronic pain patients to realize that searching for alternatives does not mean the government is going to come and take away their prescriptions that they are using responsibly to manage their pain.

We need to work together to find a solution, or we can’t expect anything to change. Hopefully Minnesota can be at the forefront of that change.

Why Chronic Pain Patients Feel Targeted By Opioid Crackdowns

pain pill overdoseAs opioid overdoses continue to rise in the US, the government, lawmakers and medical personnel are all trying to figure out the best way to reduce these unnecessary deaths. Obviously restricting access to opioids would reduce the number of people who can get their hands on them, and in turn reduce overdose deaths, but it would also unfairly target people who need the pills. People like those suffering from chronic pain. So it’s understandable to see why when lawmakers propose strict rules for who can access these medications that chronic pain sufferers feel like they are being targeted and singled out.

It’s a tough balance to strike, and unfortunately it seems that as a nation we are more focused on what is easy and cheap instead of what will really address the root problem. Putting a band-aid over a large gash might stop some bleeding, but the wound won’t close correctly without stitches. Simply restricting access opioids and painkillers might stop some abusers from getting the pills, but it won’t solve the whole problem. We need to put some stitches in place.

Solving The Opioid Crisis

We’re not going to sit here and pretend we have all the answers for solving the problem of opioid addiction and overdose, but like we said above, simply restricting access is not going to solve the problem, and many innocent people who rely on those medications may no longer be able to access them. Instead, here are some steps that will help address the root problem.

1. Doctor Education – The vast majority of doctors understand that opioids do not address the root problem, but sometimes they are confused by a diagnosis or have seen other treatments fail and they fall back on them. Other doctors cut corners and prescribe pills freely and dangerously. We need to provide better understanding at the top level of how these drugs should be used, how to spot signs of abuse and how to ensure patients are safely taking their medications so that overdoses don’t occur.

2. Systemic Pressure – This problem will be harder to solve, but in many cases doctors are told to see as many patients as possible. If a doctor is feeling overwhelmed or rushed to see a number of patients, they can sometimes fall back on easy solutions like opioids. Doctors need to take their time with each and every patient and ensure they are giving them the best care possible. It’s possible the best care will involve opioids, but it should also involve therapy, exercise and regular abuse checks.

3. Patient Education – Patients also lack understanding of opioids and their abuse potential. Opioids are not a magic pill that will cure your pain, but they can provide temporary relief so other rehab techniques like exercise, swimming or physical therapy are more bearable. Opioids are a passive treatment, and they need to be paired with an active treatment option for best results. Patients also need to learn the warning signs of abuse for themselves and for loved ones who may have access to their pills.

4. Pill Technology – Medical researchers are looking into new abuse-deterrent opioids. They are creating pills that can’t be crushed or that become gooey if a user tries to extract the solution for injection. Other pills come in an extended release form and can’t be manipulated to give an elevated or intense high. More research into abuse deterrent options could prove useful.

Simply saying we need to restrict access to opioids will not solve the problem, and many chronic pain sufferers will be affected instead of those who are actually abusing the pills. That’s why so many patients feel targeted by these proposals. It won’t be easy to reverse this trend, but if we put in the time and money, it can be done.

Surgeon General Issues Report On Addiction

substance abuse opioidsThe Surgeon General issued a groundbreaking report of the current state of addiction in America, saying alcohol and drug abuse are some of America’s most pressing public health concerns.

Substance Abuse Disorder

According to US Surgeon General Dr. Vivek Murthy, more than 20 million Americans – more than the number of people who have all cancers combined – suffer from some form of substance abuse disorder.

“Alcohol and drug addiction take an enormous toll on individuals, families, and communities,” said US Surgeon General Dr. Vivek Murthy. “Most Americans know someone who has been touched by an alcohol or a drug use disorder. Yet 90% of people with a substance use disorder are not getting treatment. That has to change.”

The report, titled “Facing Addition in America: The Surgeon General’s Report on Alcohol, Drugs and Health,” marks the first time a US Surgeon General has dedicated a report to the problem of substance abuse and misuse. Not only does the report examine the statistics behind substance abuse in America, but it also attempts to tackle the cultural shift in how substance abuse is viewed and the stigma behind it in America.

Surgeon General’s Report

According to the Surgeon General’s Report, as many as one in seven people in the US will develop a substance use disorder at some point in their life. However, only 1 in 10 receives treatment for their disorder. The report goes on to state that nearly 48 million Americans used an illicit drug or misused a prescription in 2015, while 67 million reported binge drinking in the last month. Many of these individuals are young, but substance abuse can strike at any age.

“Although substance misuse problems and use disorders may occur at any age, adolescence and young adulthood are particularly critical at–risk periods,” Dr. Murthy said. “Preventing or even simply delaying young people from trying substances is important to reducing the likelihood of a use disorder later in life.”

The biggest finding from the report was that only 1 in 10 people with a substance abuse disorder will receive treatment for their condition. Actions like the Mental Health Parity and Addiction Equality Act of 2008 and the Affordable Care Act of 2010 have helped people get access to these services, but many people choose not to get help due to the stigma associated with substance abuse.

“Families across this country are fighting addiction –they’re fighting an illness, as well as a stigma. They’re doing all they can, and we should do no less. At the US Department of Health and Human Services, we have worked hard to make our nation healthier and save lives by increasing access to evidence–based treatment for those who need it,” said HHS Secretary Sylvia M. Burwell. “While there’s more to do, this historic report provides us guidance and outlines important steps we can take to move forward, build on our progress to address this public health crisis, and make a difference for more Americans.”

Dr. Murthy says that going forward, we need to change the way we think about substance abuse disorders to lift this stigma to ensure people who need help come out of the shadows and get the help they need.

“It’s time to change how we view addiction,” said Dr. Murthy. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”

Pain Care – When Correlation Doesn’t Equal Causation

Opioid Abuse Smoking StudyIt seems that there are new articles being published almost every day on the dangers of opioid pain medications. Unfortunately a lot of the studies are not very enlightening. Worse yet, some are just sensational, dumb correlations without causation.

For instance, saying obesity is correlated to eating is a great example of poor research. If you eat, of course could run the risk of being obese, but if you do not eat you could die, so obviously these findings are not very meaningful.

The latest was an article stating that a third of all adults in the United States in the last year received a prescription of opioid medication, and this is larger than the number of people who smoke cigarettesThe reason this is absolutely meaningless is this number has no real meaning. If you add up all the prescriptions for opioids written in one year and divide by the adult population, this is very likely.

Another interpretation would be that 1 in 3 people had a serious medical issue in the last year and were prescribed pain medication. Most people who have been in the hospital or emergency room for a surgery or injury may get a short-term prescription for pain medications. This is one of the very legitimate uses of these drugs, and should not be demonized. Treating acute pain aggressively at the outset has been shown to reduce the incidence of chronic pain problems. Several days of pain medications after a surgery or serious injury is appropriate but it should not be an ongoing use once the acute episode has healed.

Making Bad Connections

A third of the world population also suffers from chronic pain. A small percentage of those people are helped only by opioid medication and use these appropriately to maintain function and ability. There are many who use these medications extremely sparingly and thus continue to be highly productive in society since then they can control their symptoms. These people are dependent on these medications, they are not addicted, and oftentimes other conservative treatments have failed them. If there were better legal treatments available, many of these people would never use opioids.

Taking a prescription pain medication for a legitimate medical problem is not a significant issue or statistic. Smoking cigarettes for most is a daily addiction, affecting 25 percent of adults. It is voluntary, it causes multiple health problems, and has a huge cost to society. Comparing pain medication use to smoking is a useless correlation with no meaning.

The Complexity of Chronic Pain

chronic pain treatment mnRecently the Star Tribune published an opinion piece titled “How not to treat chronic pain” by Ellen Stern.  The article was quite interesting, but seems to miss the mark in understanding pain and its management.  The author suffers from chronic low back pain.  She tried treating it conservatively with the traditional route of management from medications, to therapy, to injections – none were very successful.  She eventually underwent lumbar fusion and this also did not relieve her pain.  Despite all the treatment she continues to be in significant pain.

The Complexity of Pain

Chronic pain is very complex.  All of my patients understand the nature of pain and how difficult it is to find a good management option.  Furthermore, since I have chronic low back pain with significant spondylolisthesis and severe stenosis, and have close family with pain problems, I have a very deep understanding of all these issues.

Rule number one in pain management is that there is no magical treatment. Chronic pain is “managed” and not cured.  Complaining about the medical community may feel good but does not move you forward.  Adjust your attitude, if necessary get professional help, and concentrate on all the things that you can do and not on the negative.  If the physicians you are seeing are not helpful, it may be necessary to find someone who works with you better.

Opioid Abuse

The issue with opioids and abuse is nationwide.  It is now as much of a problem with accidental deaths as automobiles used to be and is ever increasing.  As the country has become more aware of the problem, all prescribers of these medications have become more cautious.  There are numerous ways to reduce abuse of opioids, and all patients who receive them are scrutinized.  As a prescriber, we are constantly trying to determine if a patient is appropriate for opioids.  Since our licenses and livelihoods are on the line when prescribing opioids, most of us are cautious when prescribing.  We all can tell stories of success as well as ultimate disasters, so please understand close monitoring of the patient receiving opioids comes with a certain level of danger.

Medical Marijuana

Medical marijuana in general is another complex issue.  As with all treatments for chronic pain, it is just another management tool.  Like any other compound, it works only for certain people and definitely not for everyone.  Further as noted in multiple previous writings, the science behind medical marijuana has been minimally studied.   There is very little rigorous research similar to any other drug that has been approved for medical use.  Many physicians are reluctant to recommend a compound that has not been adequately analyzed and has solid research behind it.  Many compounds in medicine have come on the market and we later find significant serious dangers caused by the compound.

Treating chronic pain is extremely complex.  There is no silver bullet of a cure.  There is much more that the medical community does not understand about pain than what we really know in detail.  The majority of the tools we use today are often quite crude and old.  Surgery is often quite brutal, and changes the body often in the wrong way.  Morphine and its opioid derivatives are the same concoctions that we used to treat pain over 150 years ago.  Research is slowly bringing medicine better understanding of pain.  Physicians are struggling with the problems of pain and its treatments and a lack of new and better solutions with good scientific basis.  Hopefully more funding and research will lead to better solutions in time since chronic pain does affect over 30% of the population worldwide.