Managing pain in the era of the opioid crisis

How do we manage pain in the era of the opioid crisis? – Rita Agarwal, MD | Meds | October 2, 2019

Here’s an example of another doctor who understands that the so-called “opioid overdose crisis” has nothing to do with prescription opioids or pain patients.

“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.”
So screams the headline from The Daily Beast.

“In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone,” it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about?  

Well, according to the actual article, there was no greater risks of complications in the patients who received opioids versus those who did not.

As with all the MME restrictions, no one is asking about the outcomes: is there really a lesser risk to patients (not just spreadsheets)( with less MME prescribed?

Since opioid overdoses are growing unabated (thanks to illicit fentanyl), it sure doesn’t look like it.

A tonsillectomy procedure is an extremely painful surgery, although certain techniques can decrease postoperative pain and are used by some surgeons for some patients, they are not indicated for all.

Calls for returning to no opioids are disingenuous and do a disservice to our patients.

We must treat pain appropriately, and we need to look for better analgesics, better techniques, and ways to optimize nonpharmacologic techniques.

Addiction does not occur just because there are extra pills lying around. Addiction is a disease.

Opioid prescriptions have been steadily decreasing over the past two years, and the number of opioid-related overdose deaths are finally starting to decrease too. While opioid use disorder and addiction are real problems, inadequate pain management should not be ignored.

Limiting physician’s prescriptions to patients won’t solve the opioid crisis, training, and providing high-quality mental health professionals will.

Addiction is a disease.

Unfortunately, limiting opioid prescriptions that has not stopped the continuing crisis.

The increase in overdose death in the past eight years is due to heroin and synthetic opioids. The number one culprit now is fentanyl. Knock-off fentanyl manufactured in China, cut with who knows what additives, added to heroin and other street drugs.

Further limiting prescription drugs is not going to have any impact on these deaths.

Lawmakers, with few exceptions, are not physicians. By April 2018, 28 states have some sort of limits on opioid prescriptions most focusing on the total number of days an opioid may be prescribed, others limiting the total dose in morphine milligram equivalents (MME).

Addiction is a disease, so artificially limiting or restricting medications for legitimate medical reasons is not the solution. Non–physicians (lawmakers) practicing medicine and creating barriers for patients to receive needed and appropriate treatment is not helpful.

Addiction is a disease. Chronic pain patients did not cause this epidemic and should not be punished by having their opioids stopped.

Thoughtful legislation can help us combat this crisis without hurting our ability to appropriately treat our patients. Laws should help physicians and other healthcare provider diagnose and treat this disease, not add obstacles to appropriate patient care.

Author: Rita Agarwal is a pediatric anesthesiologist.

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