Opiate use and abuse has been a hot topic on center stage in the medical community, and with recent suggested guidelines from the Centers for Disease Control and Prevention, which is working to move the medical community away from over-prescribing opiates, Eastern Plumas Healthcare has joined the front ranks of the effort to address opioid abuse.
According to the CDC, a federal agency that conducts and supports health promotion, prevention, and preparedness activities in the U.S., “An estimated 20 percent of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription.”
In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. Opioid prescriptions per capita increased 7.3 percent from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice and internal medicine compared with other specialties.
The CDC goes on to state, “Rates of opioid prescribing vary greatly across states in ways that cannot be explained by the underlying health status of the population, highlighting the lack of consensus among clinicians on how to use opioid pain medication.”
As EPHC has narrowed its focus on how to address the crisis, medical professionals across the board are coming together to make a shift on how opiates are prescribed in an effort to combat the issue head-on.
EPHC’s CEO Tom Hayes stated, “I think that our responsibility is to ensure that we work closely with our patients and providers to try and get some of our patients off of the heavier medications and into alternative therapies. We must ensure that we are actively working with our patients, from one end of the spectrum to the other, in a patient-collaborative approach.”
Dr. Michelle Kim, a Family Medicine Practitioner and Clinic Medical Director at EPHC, has worked within the community for more than five years, and opened up a bit more on the subject.
“Opiates are essentially anything metabolized or broken down in the body in a way that acts like morphine,” she said. “Examples of opiates are hydrocodone, Percocet and other long-acting relatives.”
“Now, our goal in this shift is not to disregard chronic pain sufferers, and we are not putting out the message that these medications will be phased out completely. The reality is that there are certain conditions that require opiate use, because they do have their role, but they need to be closely monitored. We evaluate on a case-by-case basis and try to make appropriate medical decisions through this evaluation.”
Kim explained that medical practitioners are looking to try every avenue possible prior to prescribing opiates to improve the patients’ quality of life. Kim also described how opiates might end up playing a part in a patients’ treatment plan, but said, “It shouldn’t be the only part of the plan — it’s about finding the balance.”
Kim noted that medical practitioners have clear goals on the use of pain medication, and ideally they would like to check in with patients to not only monitor side effects, but also to assess if goals on improving quality of life have been met or not.
“In the past, there were no real expectations for treatment [of chronic pain],” Kim explained. “People would end up getting long-term pain medication prescriptions and then they wouldn’t check back in so we could see if their life improved with the use of these medications.”
Kim went on to speak about chronic pain in particular, saying, “The way I look at it is that chronic pain is a definite diagnosis, like hypertension. We’re not denying that. Guidelines on how to treat hypertension are constantly being updated, with chronic pain medical guidelines also being updated in the same way. We are in a position where we in the medical field want to keep our patients safe, and we are also evaluating where we may have gone wrong in the last decade of prescribing medication.”
Kim referred to the fact that chronic pain patients in the EPHC network are now finding themselves a part of what she hopes will be a shift in the relationship that patients have with their medications. “We don’t want to give off the message that people are ‘bad’ for taking opiates,” Kim said pointedly. “Not everybody’s life follows a recipe and that is where the art of medicine comes in. We have to be partners with patients, and it’s a hard line to be walking.”
Dr. Wendy Flapan, EPHC’s physiatrist and pain management specialist, certified in 2005, weighed in on the complex issue as well, noting that her goal is to help people with proper diagnosis, as well as proper treatment, which includes alternatives to alleviate chronic pain aside from opiate use.
“These days, there is a pill for everything,” Flapan said. “But there are also many, many alternative modalities in controlling and treating chronic pain, which include, but are not limited to light yoga, physical therapy, stress management, chiropractics, massage and acupuncture.”
Flapan went on to explain that lifestyle choices have a lot to do with pain and pain management, and that such activities as smoking, drinking and recreational drug use are huge contributors to chronic pain patients and the exacerbation of pain.
“I really would like to promote healthful activities and get people outdoors, into the arts, and into the community through work and volunteerism,” Flapan said. “I would estimate that things in Plumas County are around 30 percent better than they were when I first arrived, four years ago.”
When asked about the response from patients that have tapered down or off of their opiate prescriptions, both Kim and Flapan had positive feedback. “Most people feel so much better and tell me that they feel as if they have come out of a fog,” Flapan enthused.
Kim also had input, saying, “There are many patients that have been on pain medication for so long that they can’t imagine a life being off of pills, but they are surprised at how clear headed they are when they do taper down.”
Healthcare providers are changing the way that they practice and according to CEO Hayes, it has everything to do with doing the right thing and following the most recent guidelines in medicine.
When narrowing the focus onto Eastern Plumas County, County Health Education Coordinator and lead for the four-county Northern Sierra Opioid Safety Coalition James Wilson spoke about the fact that since the official launch of the coalition in January of 2016, he has seen huge positive change.
“It’s become very apparent that prescribing levels in Eastern Plumas have gone down pretty substantially, which is great,” Wilson said. “This was really a huge problem, with a lot of deaths due to opiate overdose. For 2016, I’m happy to say that we had a really good year, with not a single recorded pharmaceutical overdose. We are definitely hoping that trend continues, but it’s still too soon to tell.”
Wilson explained that Plumas County is finally approaching state levels in prescriptions, as well as being one of the few counties in California that have been able to reduce the co-prescribing of opioids and benzodiazepines, such as Xanax and Klonapin, which are drugs known to decrease respiration rates and also potentially cause an individual to just stop breathing altogether.
Wilson is highly enthused at the progress being made thus far to protect and treat patients in Plumas County, and urges all to educate themselves on the topic. “I also would like to say to the community that if anyone has a family member, loved one, parent, friend — anyone, really — using prescribed or street opioids, please pick up some Naloxone.”
Naloxone is a nasal spray that instantly reverses the effects of an opiate overdose, and according to Wilson, it really works. “We started using the Naloxone spray and making it available to the public in September of 2016. Since then, we have had two reported cases of overdoses that were successfully reversed, so we know that it’s working.”
The spray is available free of charge and anonymously at various places including the Portola Wellness Center and the Plumas County Public Health Agency in Quincy. For more information regarding CDC guidelines on opiate use, visit cdc.gov, and for statistics on local opiate use and much more, visit pdop.shinyapps.io/ODdash_v1/.