Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
Recently the White House announced its initiative to stop opioid abuse with three major goals. As an addiction medicine provider at Northland treatment center in Milford, Ohio, I prescribe medication-assisted treatment to patients with opioid use disorder (OUD) every week and share this perspective on the White House’s top goal:
Reduce demand and over-prescription: educate Americans about the dangers of opioid and other drug use and seek to curb over-prescription
Education is often the first suggestion when looking for a solution, but what’s more important is the need to concentrate on the right type of education.
Most physicians and laypeople know the dangers of opioids. Since the commission’s report, it’s been established that the compulsory numbers of prescriptions of opioids Americans use or the number of deaths is intolerable. I have patients who have watched their friends die while using heroin and they keep using despite that experience.
Educating physicians about the dangers of opioids and limiting the prescriptions written is elementary. We already know the basic premise. Curbing prescription writing, safer prescribing techniques, and finding alternatives to opioids for the treatment of pain are all important educational goals. However, most of the lay and medical community are not educated about the disease of addiction. Healthcare providers need more education to recognize that addiction is a disease and that those suffering require more than disdain and disgust. Many clinicians are not comfortable or well-versed in taking care of patients for basic medical problems who are in recovery or those who are on medication-assisted treatment. This can lead to improper treatment and an increase in relapse risk.
For example, one of my patients suffers from migraines and the only medication that ever relieved her headaches was a drug called a “triptan.” It is not mood-altering and when it was first offered, it was only available in an auto injector. When my patient started her recovery from OUD and Xanax (a sedative), she went to her family doctor asking for the injectable triptan for her headaches. Her family doctor told her she didn’t want to give it to her because it was a shot and she was an “addict.” Triptans are available in an oral form but her physician did not offer this alternative. So she prescribed a medication with a barbiturate, caffeine, and codeine. The patient went to the pharmacy and realized that the medication had codeine and refused it. So the doctor changed it to one with just the caffeine and barbiturate. Even though a barbiturate is not recommended for those in treatment for OUD, since it is a mind-altering sedative, she started taking it. Although the patient knew that she should avoid codeine, she was not aware of the other ingredients in the medication.
When I started seeing her, she was taking the migraine medication very frequently, and I suggested she move to a different medication and not take the barbiturate. As she weaned herself down from the headache medication, she was also witnessing her aunt die in hospice. Since she was her aunt’s power of attorney, her stress level understandably increased at the same time that she started taking less and less of the medication for her migraines. Since she started weaning from the barbiturate (a sedative drug like Xanax), I believe it triggered her craving for Xanax.
After an emergency meeting with me, I prescribed an oral triptan. Following the barbiturate withdrawal, the Xanax craving resolved and she rarely has headaches now. Had her primary care physician been educated on how to treat a patient who is in recovery, this may never have happened. She was at a very high risk of relapse when she was experiencing physiologic withdrawal symptoms and was going through a very stressful situation. While her cravings were for Xanax, often patients will relapse on their drug of choice (in this case, heroin).