Opioids: A crooked path to an undesired destination!

I recently read a Vox.com story that really got me thinking about the opioid crisis and the complex web of factors that brought us here. I encourage you to check out The opioid crisis changed how doctors think about pain by Sarah Kliff.

Kliff writes—and I agree—that we must recognize the history of the use of opioids as we develop strategies to tackle misuse, abuse, and overdose. How can where we came from help us as pharmacists determine the way forward? What do you need to best help your patients and prevent misuse?

In the 1990s, the concept of pain as “the fifth vital sign” took off, OxyContin was introduced into the marketplace, and opioids became staples of chronic pain management. And although this is changing, over the past 10 years, focus on pain management and relief within patient satisfaction measures put pressure on providers and systems to target total pain elimination.

We all know that these and other factors led to a spike in opioid dependence and overdose deaths. Thinking has now shifted toward a more conservative approach, aiming to bring pain to a tolerable level, not eradicate it. There’s new attention to nonopioid medications and nonpharmacologic therapies like exercise therapy and acupuncture.

We also heard pain expert Elliot Krane, MD, say in his APhA2017 keynote speech that opioid prescription decisions should be based on individual circumstances, not on preconceived notions that every patient will abuse or misuse opioids—prescribers should consider risk factors like depression, economic instability, and genetic predisposition.

It isn’t ideal to just “send them on their way” when a prescription drug abuse monitoring program (PDMP) identifies a person as a possible drug seeker. PDMPs are a bit like what happens when a dog chases a car and doesn’t know what to do once it catches it. Without sufficient referral resources, we don’t have what we need to help most.

If you were in charge, what would you need to best help your patients? Better enforcement? Stricter or more lenient laws and regulations? Lower prescribing? Access to better systems (medical records and other)? More referral options? Closer ties with prescribers? Better education of pharmacists and prescribers? Reimbursement for your tapering services?

Are pharmacists and other members of the team comfortable recommending and working with patients and caregivers on alternative methods of pain management?

We’ll compile your comments and share what we hear.