Doctors: Treatment includes understanding, options | News, Sports, Jobs


The American Medical Association convened a task on opioids in 2014 due to rising drug abuse and overdose deaths.

But overdose deaths have continued to rise, due to illegally manufactured fentanyl, barriers to evidence-based care, the stigma associated with substance use disorders and how pain management is treated, according to Dr. Bobby Mukkamala of Flint, Michigan, a former American physician. Chairman of the Association’s Board of Directors and current Chairman of the AMA’s Substance Use and Pain Management Task Force.

The nation needs to change its way of thinking, especially lawmakers and those who can influence policy – especially in the insurance industry, Mukkamala said.

The task force’s recommendations have led to improvements, Mukkamala said, pointing to fewer opioid prescriptions being written and more naloxone prescriptions being written. There’s better statewide prescription oversight and more education for doctors about substance use disorders and pain management. There are also more doctors certified to prescribe opioid treatment drugs like buprenorphine.

But there were more than 100,000 overdose deaths last year, Mukkamala said.

Doctors are now much more careful when it comes to prescribing opioids, said Altoona primary care physician Dr. Zane Gates.

Years ago, they wrote opioid prescriptions for 30 or 60 days without thinking too much about it. Now they are “enormously vigilant.”

If done well, such vigilance can protect patients from addiction, according to Gates.

However, the flip side is that the small percentage of people who really need opioids for chronic pain can’t get it, he said.

“The pendulum has swung too far” along the lines of reluctance to use opioids for pain relief, said local physician Dr. Sean Hampton. “We are afraid to prescribe.”

What is needed is a balance. Not everyone with a back injury needs narcotics, but sometimes pain from kidney stones or cancer is undertreated, he said.

Looking for alternatives

By using a combination of non-addictive painkillers, exercises, and alternative methods — such as acupuncture, yoga, meditation, and chiropractic — doctors can often treat pain without using opioids.

This is good news for people with substance abuse disorders and for the general public who often worry about becoming addicted to painkillers.

In the VA healthcare system, pain management is “a combination of all these things”, said Ron Peterman, chief of pharmacy at Van Zandt VA Medical Center.

Such practices can provide direct pain relief and can improve patients’ ability to keep moving and performing routine and even athletic activities, which in turn can help put pain in the background, while improving mental health – another bulwark against pain, according to Van Zandt officials. .

“I have always been told that one of the best remedies for pain is movement.” said Shaun Shenk, acting associate director of the hospital, which uses yoga for spinal stenosis and two bulging discs.

Combining a variety of methods can allow veterans to enjoy the things that matter to them, including playing ball in the yard with their children or grandchildren, said Amy Showalter, all-around health coordinator for the hospital.

The more normally patients can function, the less likely they will be to dwell on pain, Peterman said, and the less they will need more addictive opioids.

Primary care is the frontline defense

Primary care should be the first line of the medical system to treat substance use disorders, Gates said. SUD patients often struggle with medical issues that tend to cause them to seek medical attention for help, but primary care offices need sufficient resources to properly treat these patients – and many don’t. not.

Gates’ office employs a social worker who focuses exclusively on SUD patients, who make up a large percentage of its clientele.

Ideally, primary care offices employ someone with the special licenses needed to prescribe anti-opioid drugs and other “methods of treatment”, according to Gates.

His office is integrated with Blair Drug & Alcohol and other agencies that provide addiction rehabilitation and counseling services.

Follow-up from the primary care office is essential, he said. This includes ensuring that patients who become clean stay clean through attendance at group meetings, he said.

It is very complicated and laborious.

Getting patients to seek help or admit they need help is often the hardest part, said Hampton, who added that most people in active addiction aren’t looking for relationships. primary care because they feel they will be judged, he added.

Hampton tends to see more people recovering – “who have succeeded in life” he said.

However, there are barriers.

Most significant is the high percentage of recovering people who relapse, which is disheartening for both doctor and patient, Hampton said.

There is also the widespread shortage of primary care doctors, he said.

Still, having a relationship with a primary care physician can be key for someone recovering because they need a doctor they can trust.

Mirror reporter Rachel Foor contributed to this report.



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