Physicians told changes in prescribing can avert opioid addiction

Posted on: March 22nd, 2016

By: Lauren Loricchio – Contact Reporter

Physicians from across Maryland were told in a presentation in Hanover Saturday that adjusting their prescribing practices could help the state cope with its opioid addiction crisis.

Dr. Yngvild Olsen, an internist trained in addiction services, told doctors at the Maryland State Medical Society’s annual Scientific Meeting and Expo that the prevalence of addiction in the general population is about 10 percent.

“Addiction is something that is really common and something that you’re going to see really often in your practice,” said Olsen, the medical director of Reach Health Services, a Baltimore outpatient substance use disorder program.

Opioids, a type of narcotic prescribed by doctors to treat pain, are highly addictive, and four of five heroin users got hooked after misusing prescription painkillers, Olsen told the doctors.

In recent years there has been an increase in opioid drug use and overdose deaths in Anne Arundel County, in Maryland and in the entire region. Between 2010 and 2013, the number of heroin-related overdose deaths in the state rose by 95 percent.

In 2014, Anne Arundel County ranked third-highest in Maryland in the number of deaths due to opioid misuse, behind Baltimore and Baltimore County. Last year, County Executive Steve Schuh declared a countywide public health emergency, directing county agencies to shift resources to combat heroin use.

“We have evidence that as the use of opioids went up, as the availability of them went up, we also see increases in mortality as well as increases in treatment admissions for opiate addiction,” Olsen said.

Although not all patients will become addicted to the medication, the rate is high enough that doctors should be concerned, she said.

“If we as physicians are really going to take care of the whole person, we can’t ignore the addiction,” Olsen said. And it has been ignored too much in the last 10 or 15 years, she said.

Olsen said addiction was considered a disease, to treated by physicians, in the last century, but has more recently become a criminal justice issue no longer addressed by the medical community.

“We’re still living with some of that,” she said.

Olsen suggested doctors get to know their patients and assess their pain management needs. Doctors must consider that patients can become addicted to medication and think of ways to handle that if it happens, she said.

Physicians should also inform patients about the risk of developing an addiction to opioid medication before they choose to take it, she added.

“We have somehow been giving the message that this medicine is going to fix this,” she said. “We need to reframe the conversation about how to manage pain.”

Olsen said most doctors are aware of the opioid epidemic because of information disseminated through the media and at professional conferences.

“It’s hard to escape, but the challenge is physicians get so little training on chronic pain management and addiction in medical school, so they really don’t know what to do,” Olsen said.

Dr. J. Ramsay Farah, medical director of the outpatient addiction medical center Phoenix of Health in Hagerstown, who was at the conference, agreed that the medical community has been slow to recognize that addiction is a disease.

“Unfortunately there is a gap between the health system and the health administration,” said Farah, who also teaches physicians about addiction in seminars.

Primary care physicians, who prescribe nearly half of opioid painkillers, particularly struggle with what to do, Olsen said.

On Tuesday, the Centers for Disease Control and Prevention, or CDC, issued recommendations on prescribing opioid medications for chronic pain, with the exception of cancer, palliative and end-of-life care.

The guidelines, Olsen said, are basically a return to the prescribing practices used before the opioid addiction epidemic.

Chronic pain is defined as pain that lasts for three months or more, whereas acute pain has a shorter duration.

Research shows opioid pain medication can be beneficial for acute pain, Olsen said, but it’s not clear the medication helps with chronic pain.

“Because there are those known associated harms — increased overdose deaths, concern about increasing rates of addiction — you have something without clear benefits and when there are these risks; there has to be something better,” Olsen said in an interview after the presentation.

Recommendations suggest doctors choose therapy and alternative medications before prescribing opioid medication to patients for chronic pain, and suggest doctors prescribe the lowest amount of the painkillers for the shortest time possible.

“It’s not to say that you can’t ever add opioids,” she told her audience.

Olsen said while other organizations have released similar guidelines, these will form the foundation for changes at the federal and state level.

The key, Olsen said, is that any changes will have to be accompanied by broad system changes, particularly in care delivery.

“We really are at a turning point in medicine and public health,” Olsen told the group of physicians. “It ultimately comes down to it, for me, that we need to know our patients.”

To view the CDC guidelines, go to: