Discussing news and issues in orthopedics and spine healthcare. This is Spine Talk. Hi, this is Dr. John Shim and today I'm here with Jason Mazza orthopedic assistant talking about a very important issue and that's basically the opioid crisis and we're going to review an article that was basically produced by the American Orthopedic Association titled "Leading the way to solutions to the opioid epidemic" so Jason, can you tell us about this article? Yes, so this article published in the journal of Bone and Joint Surgery from 2017. Little different change of pace for us here today this is a more of a review article as opposed to a study. This article looks at the public health crisis of opioid prescribing in America. The author's present a lot of background information about how the epidemic came to be along with identifying a lot of the risk factors associated with abuse and diversion of prescription drugs. The article closes with a discussion about a call for orthopedic surgeons and other leaders to develop solutions to address this problem. So, for the benefit of everybody when we talk about opioids we are talking about medications such as oxycodone, hydrocodone, morphine, codeine and and many others on the list. To no one's surprise you know orthopedic surgeons are in the top four on the being the top prescribers of opioids in the U.S. Some of the the interesting facts that came out of this paper and they looked at other studies the risk of addiction somewhere between 3 and 45% when used long term. In the more surprising one in patients who take opioids beyond 12 weeks as much as 50% still taking them at five years later. Now, certainly this is this is a significant public health issue that has been kind of brewing over the last 20 to 25 years. So, Dr. Shim in looking at our new prescribing laws that went into effect last year in 2018 there there's a lot more restriction to accessing pain medications now. So, are you in favor of tighter controls or do you think we should be putting more emphasis on effective treatments for pain controller or perhaps both? Well, I mean this is a very difficult discussion for patients if you're used to taking pain medications and all of a sudden the pain medications are not available to the same degree or as ease as you've had before there's a lot of concern but the truth is we do have to break this cycle. What what's happened is through no fault of really the other patients governmental agencies societies pharmaceutical industries got together and decided we can control people's pain better by prescribing these medications and there shouldn't be a lot of side effects. Well you now know there's been a lot more side effects than originally produced or actually discussed. So, for me I think we're going in the right direction but really we're trying to reset our population we're trying to reset medicine to make people a little bit more self-reliant. When we prescribe medications people think pain goes away the truth is there's a lot of coping mechanisms that you have individually as a person that you should also try to execute before you take those pain medicines. We took that ability to cope cope away by prescribing all these medications. So I think we're actually going in the right direction. Along those same lines by by limiting what we what we prescribe do you foresee kind of unintended consequences in spikes of use and deaths associated with using illicit drugs? Will patients kind of go to that side as since they can't get prescription pain medicine as easily now? Well, actually that's one of the talking points of why we prescribe these medications so we can control that better. The reality is I think we actually created more demand for these medications. If you look at the statistics, the U.S. population is somewhere around six percent of the whole world's population but we consume 80% of the narcotics. So, we have an issue here. So to me I think by unwinding the prescription habits where we basically help dick people we're actually going to decrease also the demand for these illicit drugs. I do think there may be a small spike as we do these transitions because you know people are used to a certain amount of medications but I think long term as we go away from the narcotics and people start learning their normal coping skills of how to deal with pain like the rest of the world does I think we're going to decrease use and consumption of all these drugs both prescription and illicit. Mm-hmm and I guess my last question after looking this kind of a lot more broad of a question but you know when we look at orthopedics in general we're facing a aging population we're having increased rates of obesity and other chronic diseases that put a lot of strain on the joints and spine we're living living longer live spans and perhaps there are greater expectations from patients now in terms of what they consider pain relief not even considering the social and the economic side of this as an orthopedic surgeon do you feel that our current healthcare system is prepared to manage chronic pain kind of in now and in the future? In the short term no but we're unwinding a process that we created over 20 years. So if we bring pain management back to the individuals ability to deal with their own pain the proper expectations of yes you're gonna have some pain you're not going to be pain-free but you're gonna be functional yes you can control how much medicine you take and a lot of these things are biofeedback they're self-imposed expectations that right now have been sent wrong. If we reset them properly long term I do think we're gonna have a much better handle on how we deal with people with pain. Short term we are gonna literally go through some pain as people are used to a different system. Okay. So this is Dr. John Shim, and I'm today here with Jason Mazza orthopedic assistant talking about the opioid crisis and the maneuvers that are being brought forward to medical societies to help with that crisis. I hope this bring some information to the process and why things are being changed. Thank you for listening.
Last week’s blog was on the opioid crisis and what is happening in our society where drug addiction has increased by large percentages over the last 10 years. We blame large drug companies, physicians, hospitals and of course dealers of illegal drugs, for the rise in deaths and addiction but as in any other social woe, the entire blame isn’t always on someone else.
Each one of us has an obligation to ourselves and to our children. We can blame television and video games for childhood obesity, but we need to realize that kids are not literally tied to these things. Sports, outdoor play, and parental involvement in both diet and exercise can easily prevent kids from going down that road.
Disrespect and intolerance are learned behaviors. If your children hear you speaking dismissively or rudely about a community leader, a person of another nationality or religion, or even a teacher who you don’t agree with, they think its acceptable. The example we, and the other adults in their lives, set will be with them for a lifetime. This also goes along with how we deal with the hardships we face in life. If we use avoidance, anger or substance abuse to get us through the tough times, those around us are likely to do the same.
Some drug use is unavoidable. If you are in a serious accident or have a major surgery, opioid medications are a necessity but we have to understand, sometimes you cannot be pain free. Pain is a warning. So many things such as leaks after abdominal surgery or infections in surgical sites, are missed because patients are too “drugged” to notice that something is not as it should be. In the hospital, patients need to be weaned quickly off these medications and the symptoms causing the pain need to be dealt with. Ice packs, heating pads, elevation and anti-inflammatories are all non-addictive ways to deal with pain.
In the medical world, especially the ER, we are so worried about “patient satisfaction surveys”, we give out scripts because they are expected, not because they are actually necessary. This is where a good portion of young adults get their first taste of narcotics.
Watch your children, especially the teens and early twenties. If they are injured, stay involved. They may be legally adults, but still have little knowledge of how medicine works and can often end up trusting someone they shouldn’t. Talk about drugs from the time they are small. Discuss stories in the news. Ask questions about the medical care they are receiving and talk to a trusted medical person in your life who understands what should be happening, compared to what is.
In the end, the responsibility is ours. We need to learn that we cannot always be pain free. Sometimes pain is there to tell us something is wrong, or it is short lived. Discard unused medications instead of holding on to them, be careful where you keep them (not the medicine cabinet), educate your kids and realize that just because these meds are given to you, it does not mean you have to take them.
- Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM, Centers for Disease Control and Prevention (CDC).. Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013. MMWR Surveill Summ. 2015 Oct 16;64(9):1-14. PubMed PMID: 26469747