On October 26th of this year, President Trump declared the opioid crisis a public health emergency. This may have been an understatement when you consider that drug overdoses last year were the leading cause of injury death surpassing both motor vehicle accidents and gun related deaths. More people will die this year from opiate overdose then died during the entire Vietnam War. Nearly 224,000 Coloradoan’s misuse prescription drugs each year and our drug overdose rate is significantly higher than the national rate. It is spilling over into our children as Colorado kids have one of the highest illicit drug utilization rates in our country. In this century 183,000 deaths have been attributed to prescription opiate overdoses. Don’t gloss over this number. That’s 183,000 families that will never see their loved one again because they overdosed on a medicine prescribed to treat pain.
So what are we doing about it locally? Grand River Hospital has taken a very deliberate approach to combating this crisis. We are limiting the number of pain pills prescribed for ER visits and do not treat chronic pain in our emergency room. In fact a recent external audit our administration had done suggested we could be even more restrictive in the number of pain medications written for. We have done more and more random drug screens on both ER and clinic patients to test for illicit drugs and require our patients with chronic pain issues to sign a pain contract with their primary care physician. This limits Doctor shopping and hopping from pharmacy to pharmacy. We participate in the Colorado Drug Monitoring Program and use it as a tool to check past or recent inappropriate opiate usage. We have brought in specialists to educate our staff on drug diversion as well as show us the alternatives that are available for the treatment of pain that does not involve a narcotic. Recent studies suggest that opiate pain killers may serve as pain modulators meaning they may actually increase a patient’s pain level when they wear off. With this knowledge we find it prudent to limit post-op pain meds. Grand River Health is currently pursuing an addiction specialist to have on staff to help the underserved in this community when they have nowhere to turn. I feel these measures are making a difference and if you look at the state’s health outcomes statistics, Garfield county ranks in the lowest 20 percent for age adjusted opioid analgesic death rate and in the second quintile for opioid related ER visits. This of course has come at a price. Patients with pain may go undertreated and have the feeling of judgement levied against them by the medical community.
So how did we get into this crisis? I would start by saying that opiates are a highly addictive medication. It is not a character flaw, nor a sign of weakness to become addicted to this class of drugs. Without question this has to be the number one reason and without available resources to treat people suffering from this, there is no way to break the cycle of addition and subsequent drug seeking behavior. I cannot imagine the hopelessness a person must have when they cannot get out of the grips of their addiction. Lying, stealing and buying drugs off the street become a way of life to prevent withdrawal. For those looking to make a quick buck, prescription opiates are a prime target to acquire with their health insurance copay and then mark up at street value rates.
Doctors have an obvious role in all of this. We have shown poor judgement at times. We are taught to provide compassionate care and alleviate pain with all the means at our disposal. In our quest to heal and help we have given patients the benefit of the doubt all too often. On the other hand we may have been “burned” repeatedly by our desire to help thus forming a potential bias against all pain patients. This proverbial “boy crying wolf” sentiment leaving an entire population of patients with legitimate pain concerns caught in the middle. This thing is, pain is subjective. We can do a physical exam and tests as well as monitor vitals in an attempt to objectify pain but there simply is no lab test to quantify a pain level. I will never understand why one patient gets rolled over by a horse and breaks his back and multiple ribs and gets relief with Tylenol and the next patient rates their pain a ten out of ten with a sprained ankle. That broad of a pain tolerance scale can be immensely difficult to make sense of.
As CMO of Grand River Health, I field complaints on both ends of the spectrum. “The ER ignored my pain and judged me from the minute I walked in”. I wholeheartedly agree that all patients should be treated with compassion and dignity and will encourage our staff to approach each patient with a clean slate while adhering to our strict opiate policy, as the other end of the spectrum is that of a teenage child dying of an opiate overdose. ..this leaving the family to wonder why this drug even exists and why was it on the street.
The problem is real, the solution complex.