Page 6

OMA Medicine in OR Winter 2015 2016

FROM THE PRESIDENT Nancy Hutnak, DO President Oregon Medical Association nancneal@wildblue.net The answer is not just to prescribe less, but that we need a more comprehensive approach to pain management that not only addresses the physical aspect but also the psychosocial aspects. Taking Leadership in a Different Direction OREGON HAS A LONG-STANDING HISTORY of health care innovation, but one area where we rank as a leader shouldn’t make us proud: that of being the state at or near the top for the past few years as having the highest rate in the nation of prescription pain medication abuse. In addition, the majority of drug overdose deaths in Oregon are now associated with prescription opioids, and total drug overdoses in the state have surpassed those from motor-vehicle accidents. Since 2000, the number of opioids prescribed in Oregon has doubled. By 2013, about one in four Oregonians had received an opioid prescription within a 12-month period. As articles in this special issue of Medicine in Oregon explain, treating pain as the “fifth vital sign” has created unanticipated problems and suffering. After the Joint Commission established “the fifth vital sign” standard in the early 2000s, what was intended for hospitals was extrapolated to other settings. The message to medical practitioners became “overprescribing is better than underprescribing.” Given this emphasis on pain control with every encounter and mandated pain education with little scientific basis, along with pressures of efficiency and patient satisfaction, practitioners felt pressured to prescribe pain relievers. Another result of this emphasis on treating pain was that patient expectations changed. Patients became accustomed to receiving prescription opioids, including higher potency opioids, and our culture unrealistically set as an objective that we should all be free of pain. However, our emphasis as practitioners should be more on improving function and controlling pain adequately so patients can function well. We are caught in the middle. If we prescribe painkillers and addiction occurs, we feel some responsibility that we started this cycle. If we don’t prescribe opioids and pain isn’t treated, we are seen as not doing our jobs. Our patient satisfaction ratings go down. It’s a no-win situation, and it’s time for this cycle to change. Opioids present a double-edged sword. When abused they ruin lives. When appropriately prescribed, opioids can effectively allow some patients a much improved life. Although we need to do everything we can to prevent the misuse of these pain relievers, we also need to be vigilant about treating pain appropriately. A constant tension exists between how we balance compassion and the desire to alleviate pain and suffering, versus how to avoid misuse and abuse. Notably, in many smaller communities such as Baker City, where I practice, there is a dearth of nearby pain management specialists and alternative resources. With no pain management specialists in our area, weaning a patient off narcotics and getting pain controlled can be a Herculean task. We also need more efficient practice tools. For example, the Prescription Drug Monitoring Program (PDMP) can be useful. However, communities such as Baker City that border other states need access to a national resource or other states’ drug monitoring data. Oregon’s PDMP helps me in the emergency room, but patients from neighboring states may slip through the cracks. What worries me is that with all the scrutiny and attention to the misuse of prescription pain medication, prescribers are going to be reluctant to treat pain at all. We need more evidence-based education, 4 Medicine in O Oregon www.TheOMA.org


OMA Medicine in OR Winter 2015 2016
To see the actual publication please follow the link above