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New standards may help curb opioid abuse

We have no doubt that over time, Mayo doctors will prescribe smaller doses of opioids. But the fact is that today, much more so than in the past, medicine is a partnership between the patient and the physician.

The following editorial appeared in the Rochester Post-Bulletin.

Has a doctor ever asked you to "rate your pain" on a scale of 1 to 10? And did you struggle to answer that question, wondering whether your aching back qualified as just a 6 or truly deserved the solid 9.5 rating that you wanted to give it?

If so, you've gotten at least a glimpse of how difficult it can be for medical practitioners to prescribe pain-killing medications.

Last month, the medical journal Annals of Surgery published a study of the prescribing habits of Mayo Clinic doctors in Minnesota, Arizona and Florida. The research analyzed records of more than 7,000 surgical patients from 2013 through 2015, and the authors concluded that 80 percent of prescriptions exceeded new state guidelines for opioid use.

That's worrisome information, especially in light of the well-deserved attention being paid to the nation's epidemic of opioid addiction and abuse, but this isn't a "smoking gun" moment that discredits Mayo Clinic and its doctors.

Quite the opposite, in fact.

For starters, the study of these 7,000 surgical patients was performed by Mayo Clinic researchers, including a general surgery resident and the scientific director of surgical outcomes research at Mayo's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

So Mayo studied the prescribing habits of its own doctors, then published the results. On a "transparency scale" of 1 to 10, that should qualify as a 10.

Then there's the fact that the new guidelines, drafted by the state Department of Human Services Opioid Prescribing Work Group, attempt to apply general recommendations for a wide variety of procedures that can vary widely in terms of post-operative pain. Patients who've undergone knee replacement, for example, need higher levels of opioid painkillers in the days immediately after surgery than patients who've undergone less-invasive procedures.

Mayo isn't downplaying the results of this research. The clinic acknowledges that over-prescribing opioids is a problem on its campuses, and Mayo is beginning to develop tiered guidelines for various procedures so that doctors have better protocols to guide them in managing patients' pain. "For some of the procedures, the guideline is probably appropriate and we have an opportunity to reduce the amount prescribed," said Dr. Elizabeth Habermann, the study's senior author.

We have no doubt that over time, Mayo doctors will prescribe smaller doses of opioids. But the fact is that today, much more so than in the past, medicine is a partnership between the patient and the physician. Gone are the days when patients were expected to sit quietly, listen to the all-knowing doctor and blindly follow his or her orders.

Modern medicine requires communication, and patients can and do play an active role in determining the best course of treatment.

That's why patients need to fully understand the risks of opioids and have realistic expectations regarding pain management. They need to ask their doctors to explain any possible alternatives to opiods, and they must accept that in some circumstances, a certain level of temporary pain is to be expected.

Mayo, in other words, is declaring that pain management doesn't necessarily mean pain elimination. Just because a pill can make pain go away doesn't mean it should be prescribed, no matter how eagerly the patient might ask for it.

But the sad fact is that even if Mayo becomes the new model for how to manage pain with the minimum of opioids, we'll lose the battle against opioid abuse unless other doctors and health systems across the nation unite behind the same goal.

Republished with permission.

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Comments (1)

This Article Seems to Assume

without presenting any evidence to support such an assumption,...

that all opioid abuse is the result of doctors being too generous in providing their patients with opioids.

As I understand the situation (with the exception of a few pill mill clinics in the Southeastern states)...

this is not the case.

It's possible, even likely, that certain patients begin with a post-operation prescription for opioids,...

quickly grow dependent on them,...

then seek alternate sources (street drugs) when their doctors say the time has passed for their medical condition to justify opioids.

I'm left to wonder if there is a set of underlying physiological or psychological issues that make some people far more likely to become dependent on opioids,...

even when prescribed in low doses after an operation or injury.

Perhaps discovering those underlying causes and screening for them would be helpful in determining when to prescribe opioids,...

rather than just doing what the department of health so often does,...

seeking to use a one-size-fits all solution to the use of opioids,...

while completely ignoring the reality that some people will never have a problem with them,...

and others will always have a problem with them, no matter how carefully they're prescribed.

Meanwhile, department of health guidelines are now creating a situation where people with long-term, untreatable, intractable pain,...

people for whom opioids make the difference between their being able to function in any way, day-to-day,...

even people who have, for many years, been able to use opioids carefully and responsibly,...

are left without a remedy for their chronic pain,...

opioids now being precluded as such a remedy by state guidelines.

Such folk are left, then, to either suffer and NOT be able to fulfill the daily tasks of their lives,...

or turn to very expensive high-tech solutions which may, or may not provide relief.

I can only hope that a better solution will be found for the current epidemic of opioid overdoses,...

because I fear that simply limiting the availability of opioids through legitimate sources,...

may drive people who are inclined to addiction and abuse to illicit drugs,...

cut them off from those who might have monitored (but too often don't) their use and recognized a developing addiction,...

and leave folks inclined to develop issues with opioids using them from sources where variable strength and purity far too often result in accidental overdoses.

Indeed, it seems quite likely to me that this current crackdown on legitimate opioid prescriptions is going to make the problem of opioid overdoses much worse.

But hey! All the medical professionals and the State Department of Health will be able to wash their hands of whatever carnage results,...

because the professionals didn't write the prescriptions,...

and the use which resulted in an overdose was outside state guidelines.

Very convenient, but the dead will STILL be quite dead.