From prescription to addiction: Doctors respond to opioid epidemic

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COLUMBIA - In the past two decades, the number of fatal opioid overdoses has skyrocketed, and the medical community has taken notice.

KOMU 8 News reached out to several local doctors and health groups to find out what the professional medical community is doing to try and get a reign on the epidemic.

The problem:

Dr. Brad Noble, who works at the Pain Management Clinic at Boone Hospital, said the amount of opioid misuse in the United States is cause for great concern.

"Since 1999, we've seen a quadrupling in the amount of opioid prescribed, and a quadrupling in the amount of opioid deaths in the United States," Noble said. "More people are dying of prescribed opioid overdose than car accidents."

Dr. Maria Coffman, who runs the practice Hands On Health in Columbia, said one factor in the increase of prescribed painkillers was a change in how hospitals were assessed and accredited.

"In the 90's and 2000's, we really had a switch in medicine's perception of whether pain was OK or not OK," Coffman said. "It actually became a measuring factor for if good care had been received. To leave an office or hospital with pain, or to have experienced pain during one's stay, was perceived as poor care."

Coffman said the new scale of assessment pressured hospital staff to be much more proactive in eliminating any pain, often by prescribing narcotics.

Noble said around 15 to 20 percent of people who use opioids end up misusing them at some point.

He said at first, opioids can seem like some sort of performance-enhancing drug. However, Noble said, that feeling of invincibility is fast-fading, and what feels like "performance enhancement," soon devolves into a crippling dependency.

"It's like running to keep up with nothing," Noble said. "They're not even getting high anymore. I hear that all the time. They are just using to maintain."

Noble said, at that point, patients have to take the drugs just to feel normal, not to get high.

The response:

Noble said the medical community created two strategies to combat this epidemic: Help those who are currently addicted, and prevent people from becoming addicted in the future.

Noble said the first strategy revolves around a drug called "Suboxone."

"Suboxone is a medicine we use for opioid treatment," Noble said. "It has an opioid, and opioid blocker in it. It's sorta like Methadone, but with Methadone, patients who are recovering from addiction have to report to the Methadone clinic everyday. But with Suboxone, doctors get this special waiver or license to prescribe the medicine for a month at a time."

Noble said giving patients a month's supply of medication can make the recovery effort much more convenient for those addicted. He said breaking an opioid dependency is hard enough on its own, and the medication will allow health care providers to give patients a foundation to start the journey to recovery.

"What Suboxone does is it chains up the disease of addiction long enough for the patient to develop a recovery plan that works for them," Noble said.

Even with the benefits of Suboxone, Noble said, overcoming addiction is a challenge.

"Unfortunately, opioid dependence is extremely difficult to treat," Noble said. "No matter how you go about it, you've got a 5 or 10 percent chance of successful treatment long term."

Nobel said the numbers prove a patient's best bet to beating addiction is usually a 12-step recovery program

Opioid alternatives:

Coffman said in the last 15 to 20 years, the medical community has started to rely less on prescription drugs to treat pain, and placed a stronger emphasis on alternative treatments.

"There's been a pendulum swing in health care, coming back to the basics," Coffman said. "Looking at nutrition, lifestyle... and then fine-tuning things like sleep and so forth. It sounds like it's new, but it predates all of pharmacy."

Noble and Coffman said most opioid alternatives are simple, yet often neglected, pain management solutions.

Some alternatives include re-positioning a patient, providing a cool or warm compress, taking an Epsom salt bath, getting quality sleep and maintaining a positive attitude.

"Something as simple as heat or ice, even cognitive behavioral therapy," Noble said. "Get rid of the negative thinking."

Coffman said alternative pain treatments revolve around accessing the body's own healing mechanisms, which is much more beneficial than simply numbing the pain.

She said doctors often assume their patients have already tried these "home remedies" before they come to receive medication. However, that is often not the case.

"We are so advanced in health care and medicine in the United States, that we almost take it as a given that these basic measures have already happened at home," Coffman said.

She said people need to give the old "grandma remedies" a try before they consult their doctor about receiving narcotics.

The bottom line:

Both Coffman and Noble agree, opioids are an effective way to treat acute or ongoing pain. But at the same time, they are not "miracle drugs."

"Opioids alone are not the answer," Noble said. "We want to prescribe these medications in a responsible fashion, with urine drug testing and pill counts, and we want to offer alternatives. Alternative methods to manage the pain, in addition to the opioid, if it's prescribed."

Coffman said opioids, when used appropriately, can help provide quality health care. However, she said, it should be noted that opioids do not remove the cause of pain, they simple disrupt the body's ability to feel the symptoms.

"It does not change pain, it does not change the cause of pain," Coffman said. "The problem is still there. The interpretation has changed."

For patients who are already struggling with opioid addiction, Noble recommends asking their doctor about Suboxone, and considering enrollment in a 12-step recovery plan.

To prevent addiction before it happens, Coffman said, patients should try the alternative pain treatment options before they as their doctor for narcotics.

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