Use of opioid-alternative pain medications is surging as the
U.S. tries to wean off the addictive painkillers, giving physicians
concern that the opioid crisis will be substituted by a new prescription
drug epidemic, according to a new report.
Nearly two-thirds of primary-care physicians shared that
sentiment while nearly three-quarters worry that chronic pain patients
will turn to illicit drugs if they do not have access to prescription
opioids, according to a new report
from Quest Diagnostics, which polled 500 primary-care doctors and
analyzed 4.4 million lab test results. The report reflects physicians’
apprehension that the healthcare system is ill-equipped to properly
transition from an over-utilization of opioids.
“What most fail to realize is that we
have a dual crisis in this country,” said Dr. Jeffrey Gudin, a senior
medical advisor for Quest and a pain management specialist at Englewood
Hospital and Medical Center in New Jersey. “There is no question that
people misuse substances that make them feel good, but there is also a
crisis of chronic pain, of which there is no cure.”
It is considerably harder to treat chronic pain patients,
83% of physicians surveyed in the report said. A similar share said they
are reluctant to take on patients who are currently prescribed opioids.
“Not a day passes that a patient doesn’t shed real tears about having opioid doses tapered,” said Gudin, adding that guidelines
the Centers for Disease Control and Prevention issued in 2016 led to a
widespread reduction in opioid doses without alternative treatment
options.
More than 70% of doctors said that although there will
likely be a decrease in opioid-related deaths, more patients will not
have their pain properly managed.
Meanwhile, gabapentin—an anticonvulsant that can be used to
relieve neuropathic pain and is often prescribed as an alternative to
opioids for managing chronic pain—was detected in more than half of
opioid overdose deaths, according to the CDC. Quest’s data show that
13.4% of patient test results showed non-prescribed gabapentin in 2018,
up from 9.6% in 2017. Gabapentin trailed only marijuana and alcohol at
14% each.
Gabapentin is one of only three drug groups for which
misuse, often improper combinations of drugs, increased from 2017 to
2018. The other two were alcohol and nonprescribed fentanyl. Physicians
were also concerned about the abuse of benzodiazepines and amphetamines.
“Pain patients have learned if their psychiatrist gives them
Valium, then they don’t tell their doctor because they won’t give them
opioids,” Gudin said. Part of it is on the patient; part is on the
clinician, he said, adding that Quest has been promoting a major
educational campaign about drug mixing.
Physicians may be overconfident in their ability to
recognize prescription drug misuse and drug mixing is often
underestimated, the report indicated. Nearly all doctors felt confident
in their ability to discuss risks associated with prescription drug
misuse with patients, but only 55% said they actually addressed it with
most of their patients who were prescribed controlled substances in the
past month.
Physicians recognized that they need help monitoring
prescription drug use. At least seven out of 10 doctors said that they
wish they had more training on how to taper off opioids, when to refer
patients to pain specialists, how to spot addictive behavior and what to
do after the fact.
Prescription drug monitoring helps, the vast majority of physicians said, but half indicated that there are cost and access obstacles.
More patients are using acupuncture, physical therapy,
massage and other pain-management alternatives, although payer coverage
issues remain, Gudin said
“These are things that are not taught in medical school,” he
said. “I think the medical society needs to do a better job educating
doctors on the front line, which are primary-care clinicians.”
https://www.modernhealthcare.com/providers/non-opioid-medication-rise-us-combats-opioid-crisis
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