In Depth: The other side of opiates

May 12, 2017 10:15 AM

There's no question opioid drug use is out of control in this country. In 2015, more than 20,000 deaths were attributed to overdose from prescription pain relievers.

Most were people who got the drugs illegally or used them inappropriately.

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However, these drugs can be highly effective. They work by reducing pain messages sent to our brain.

As we crack down on abuse, those in need are left to suffer.

"That's the double-edged sword. I mean, there are a huge cohort of patients across the United States that are having difficulty getting their opioids if they need them," explained Dr. Jeffrey Fudin, Pharm. D., a pharmacist and expert in the field of pain management medication.

It's the result of the crackdown on illicit drug use. So people suffering from cancer, certain chronic conditions, or an acute pain crisis find fewer doctors willing to prescribe opioids because they're under scrutiny and even when the meds are prescribed, the patient is often cast in a negative light.

"Sickle cell patients have been having this drug seeking issue for a number of years now," noted Shakir Cannon, who has sickle cell disease.

There's no cure. So once a month, he undergoes a blood exchange to manage his illness, swapping out his misshapen red blood cells, the hallmark of the disease, for healthy ones. However, it's no guarantee he'll be pain-free.

"Just completely excruciating throughout the entire body," he described.

If he doesn't manage it immediately with a prescribed opioid, it can grow ferociously.

"I just start taking hydrocodone, Tylenol," he noted.

So far, his doctor has been his partner in pain management, but the war on opioid abuse is having an effect.

"I feel that just asking for that I need more pain medication, the doctors just kind of think differently about me," admitted Cannon.

Active in the national sickle cell community, Cannon hears about patients almost daily, who are denied opioids when they present to an emergency department in crisis. 

"Of course that should never happen," acknowledged Dr. Edward Apicella, an interventional pain specialist.

However, it does and that troubles Apicella.

"There are cases where opioid prescribing is perfectly appropriate in appropriate doses to the appropriate patient. A lot of work has to go into deciding who that is and how much to give them," he explained.

Apicella and Fudin say that is at the heart of this issue. Rather than withhold appropriate opioid treatment, both argue for greater awareness about pain management in the medical community.

"Education, education, education. You have to do a lot of homework before you write that prescription," advised Apicella.

That means a detailed patient history and close follow-up and reticence to write these prescriptions has been fueled by recent Centers for Disease Control dose limit recommendations.

Fudin says that can be onerous on people who rely on ongoing, opioid treatment. It increases doctor and pharmacy visits. With an estimated 100 million Americans suffering chronic pain, perhaps one million New Yorkers may be affected.

Apicella says he rarely writes a prescription for opioids these days as there are many other pain management tools, but acknowledges sometimes opioids are the best choice.

Both doctors say it's important to recognize different classes of opioids and how we react, can depend on our genes.

To ensure the right patient gets the right drug in a crisis situation, Fudin would like to see a chronic pain registry.

"I’m working with a group, a national pain group to actually have a registry for chronic pain patients, where they can go to the ER with a card, where there’s a portal where people can sign into," explained Fudin.

They could be dosed and monitored.

Cannon already uses a web-based tool for sickle cell patients and carries a card with his diagnosis, drug treatment and doctor information in the event he’s out of town and needs pain meds, stat.

"Through the grace of God, I'm still here," beamed Cannon.

An estimated 5 to 8 million Americans use opioids to treat chronic pain. Many were started on the drugs before the risks were recognized. If you're among them, the experts say work with your doctor to ensure appropriate treatment. Get a note from your physicians you can take with you that details your condition and treatment along with the doctor's contact info and make sure that note is updated so you can present it to an emergency room in the event of a pain crisis.


Benita Zahn

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