Over the last two decades, about 2 million people in the U.S. became addicted to opioids after being prescribed pain killers following an injury or illness. The National Institute on Drug Abuse and other studies say an increased emphasis on pain-management two decades ago contributed to an increased reliance on prescribing opioids. In this installment of our series, Opioids: Turning the Tide in the Crisis, WKSU’s Kevin Niedermier looks at what role this has played in the deadly epidemic and how it is changing the way medical students are being taught.
An estimated 76 million Americans suffer from chronic pain.
One new doctor who's learned better ways to treat that pain is Elliott Schwartz. He graduated from the Case Western Reserve medical school and is doing his residency at St. Vincent Charity Medical Center in Cleveland. He says looking for a past history of addiction in patients is one key, be it opioids, alcohol or other substances. And, he says that means convincing patients there are alternatives.
Medical students hope changes will help
“I think as people realize there are ways to manage pain without these strongest pain killers, without these opioid medications, we’ll probably see a shift away from this chronic use of opioid meds.”
Schwartz took a relatively new, but optional fourth-year class at Case on responsibly prescribing pain medication, a reaction to the epidemic. It's taught by Dr. Ted Parran who specializes in addiction medicine. Parran says about 20 years ago, leaders in the medical profession decided that serious pain -- including long-term pain -- should be aggressively treated. And, they agreed that opiates seemed to be one good way to do that.
He says this war on pain coincided with other factors to help create today’s opioid problem.
Making pain treatment a priority
“Health-care organizations were being told to screen for pain, and if it’s there, assess it, and if it’s serious, treat it. Not necessarily with opiates, but treat it.
"And then, finally, patients satisfaction surveys started coming out routinely at exactly the same time, and it really was the perfect storm. If you want patients to be satisfied treat their pain, the quickest way to treat their pain and the simplest is to just give them opiates.”
Parran says the roughly 1-in-10 patients who are most likely to become addicted due to their brain chemistry don’t begin showing the signs for one to two years. It's a time during which they are building up a tolerance to the drugs. But initially, studies on patients being treated with opiates were nonexistent after three-to-six months, and it seemed like everything was working fine.
Opioids seemed like a safe, effective answer
“After people had been on these meds for a year, year and a half or two years -- and now were chewing them and selling them and buying them on the street and switching to heroin and doing all these awful things and having all these terrible overdoses -- the cat was out of the bag already.”
NEOMED, the Northeastern Ohio Medical University, also offers a course on pain management and de-emphasizing the use of opioids. It was established about four years ago in response to the epidemic. Dr. Bill Smucker, who teaches the course, says there are better alternatives to opioids for chronic pain.
Mind control and other methods
“The approaches that work include you doing mind- control things, and by that I mean deep breathing, relaxation, doing physical therapy and exercise, perhaps doing cognitive behavioral therapy with a psychologist or a behavioral -health consultant.”
But, Smucker says patients are resistant to that approach.
“I think the most important thing we’re teaching right now is to begin to teach physicians to begin to teach patients that we’re going to begin to make a shift from, I’m giving you pain medication while you have your broken bone, but the pain is going to be your responsibility, it is going to shift be more your responsibility. Of course I’ll help you, but opioids are not the single, simple fix for it.”
A tough doctor-patient discussion
Nakle Singh is a third-year student at the Case medical school. He recently attended a lecture by Parran on addiction; the class focused on addiction and prescribing pain killers will come in Singh’s fourth year. He says he’s aware of the opioid crisis, and during hospital rounds he’s seen how difficult it can be to reduce dependence on pills.
“Those conversations come up with attending physicians, and they’re usually very awkward encounters to witness because there really is a struggle between provider and patient."
But med schools across the country have recognized that that conversation needs to change.
The Association of American Medical Colleges says almost all of the approximately 140 medical schools in the U.S. now offer courses de-emphasizing the prescribing of opioids and other powerful pain killers.