In 2013, Dr. Phillip K. Chang had what he calls an “eye-opening moment.”
Chang had used his prowess as a trauma surgeon at the University of Kentucky to repair a young man’s injuries from a vehicle crash, only to have the pain medicine he prescribed leave his patient addicted to opioids.
Many physicians have had that moment. Chang, who saw the pattern repeat in other patients, says it “could happen to our family, our neighbors, ourselves.” The pain of withdrawal is no less real than the pain of broken bones.
Chang and his team began thinking about less risky ways to treat acute pain, and this weekend he will tell the Kentucky Medical Association how they were able to halve the amount of opiates given to trauma patients without increasing their pain levels.
KMA is dedicating its annual meeting to educating physicians about ways to combat an opioid epidemic that mutated into a heroin boom, claimed 1,404 lives from overdoses in Kentucky last year and put the state in the lead for hepatitis C.
Two developments of the 1990s spurred this crisis: Pain was added as a vital sign by the hospital accrediting commission. And the pharmaceutical industry targeted physicians with aggressive and misleading marketing of opioids, flooding Kentucky with powerful painkillers, many of which were diverted into the black market.
Medicare grades hospitals and bases reimbursements in part on what patients report about their pain control, creating a financial incentive to over-prescribe painkillers. Even among non-surgical hospital patients, half were prescribed opiates in a study of 1.14 million admissions.
Medicare should remove or revise its pain questions on patient surveys. And insurers should save themselves future costs by paying for alternatives to opioid painkillers.
Chang said KASPER, Kentucky’s electronic reporting system, alerted him to his patient’s doctor-shopping. (Thank you, Congressman Hal Rogers.) In four weeks, someone who had no history of drug abuse when he entered the hospital had been prescribed an alarming number of pills.
With the resources of UK Healthcare at hand, Chang called a drug counselor and they confronted the patient and offered help.
Doctors and hospitals have huge roles in preventing addiction and also avoiding relapse. After just three days of taking prescription painkillers, the risk of chronic opioid use increases and goes up rapidly after that, according to a study by the Centers for Disease Control and Prevention. Opioid prescribing has declined somewhat in this country but is still greater per capita than in 1999 and almost four times the rate in Europe.
Chang, who last year became UK’s chief medical officer, says inpatients are “super receptive” when educated about the opioid risk and included in tailoring pain-control regimens, ranging from non-opioids such as Tylenol and Advil to numbing medications that don’t deliver opiates to the brain. Chang and his team also are integrating art, music and touch therapies into treating acute pain.
They were able to achieve the same level of pain control with half the amount of opioids. Such success among trauma patients certainly could be replicated in other populations.
Rather than eliminating pain, Chang aims to keep pain “tolerable” — a standard that Medicare should adopt.
Kentucky’s legislature this year enacted what Chang calls a “game changer” — a three-day limit on opioid prescriptions for acute (as opposed to chronic) pain. The new law creates opportunities for doctors to educate their patients about non-addictive options.
The opioid crisis demands a well-funded comprehensive plan, including a way to provide treatment on demand. Doctors have a huge role in educating patients and preventing addiction. It’s good to see Kentucky’s doctors talking about how to meet that responsibility to patients and public.