An opioid addiction crisis is devastating communities across the United States, and Virginia is certainly not immune to the issue. In November 2016, in fact, State Health Commissioner Marissa J. Levine, MD, MPH, FAAFP, declared the commonwealth’s opioid addiction crisis a public health emergency.
The statistics regarding overdoses in general—and opioid overdoses in particular—are staggering, revealing a problem that is growing in scale. In 2013, drug overdoses were the leading cause of unnatural death in Virginia. The following year, for the first time, more people died in the commonwealth from opioid overdoses than in motor vehicle accidents. And in 2016 alone, more than 1,100 people in Virginia died from opioid overdose. According to the Commissioner’s report: “in the first half of 2016, the total number of fatal drug overdoses in Virginia increased 35 percent, when compared to the same time period in 2015.”
Opioid addiction does not discriminate, and can affect people of all ages, races and socioeconomic backgrounds. Every community is potentially at risk.
At Sentara Martha Jefferson Hospital, we strive to use effective safeguards when it comes to prescribing opioids for pain management. Our physicians are dedicated to educating patients about the risks of taking prescription painkillers like oxycodone, methadone, fentanyl and morphine, and they are cautious about overprescribing these potentially addictive substances.
Three Sentara Martha Jefferson providers— Jeffery Alberts, MD, of Piedmont Emergency Consultants; Joseph Evans, MD, of Sentara Martha Jefferson Internal Medicine; and John Hall, MD, of Sentara Martha Jefferson Orthopedic Services—discuss how they work diligently to manage prescription opioids safely for patients who need them. Here’s what you need to know:
Why are opioids prescribed?
Prescription narcotics, including opioids, generally are reserved for treating chronic pain and acute pain due to injury. In the hospital’s Emergency Department (ED), limited amounts of opioids are prescribed for acute pain, such as a fracture or other injury. “In the ED we do not typically prescribe pain medications for chronic conditions, however,” says Dr. Alberts. “Such prescriptions are best administered by primary care doctors and pain management specialists.”
Orthopedic surgeons primarily prescribe opioids for postoperative pain or pain due to injury. The number of pills prescribed may be intended to last from just a few days to several months, depending on the patient’s diagnosis.
Internal medicine specialists, on the other hand, evaluate patients over a longer period of time and usually try to manage pain first with nonpharmacologic measures such as heat, ice, rest and physical therapy. They also may have patients try nonopioid medications like acetaminophen, anti-inflammatory drugs or muscle relaxers. When those measures fail, prescription narcotics may be discussed.
“We try to balance the risks of significant side effects, tolerance, addiction—and in severe instances, even unintentional overdose—with the need to adequately address our patients’ pain,” says Dr. Evans.
How many pills can be prescribed at once?
Sentara physicians follow state guidelines in prescribing opioid medications, and these recommendations vary according to diagnosis.
“While we may prescribe a higher quantity for our patients who are being managed for chronic pain, new state guidelines require us to see our patients at least every three months to assess response to therapy and need for ongoing treatment, as well as to perform urine drug screening,” says Dr. Evans, referring to internal medicine practices.
In December 2016, Sentara Healthcare announced that all of its hospital-based and freestanding EDs were adopting safe prescribing guidelines for opioid medications. These protocols include not administering intravenous or intramuscular opioids for relief of chronic pain conditions; not providing replacement prescriptions for prescribed opioids that have been reported as lost, stolen or destroyed; and not prescribing long-acting opioids, such as oxycodone, methadone or fentanyl patches. The ED also does not prescribe more than 20 opioid pills at a time, and does not offer refills.
What safety information is given to patients when they are prescribed opioids?
All three of the Sentara providers interviewed said they regularly discuss with patients the side effects of narcotics, which include drowsiness and potential addiction. They also urge patients to read the written information distributed by their pharmacy when a prescription is filled. At Sentara Martha Jefferson Internal Medicine, patients are required to review and sign a written agreement outlining the risks of opioid medications and the patient’s responsibilities regarding taking the medication.
What safeguards are in place to help doctors distinguish between patients who truly use opioids for pain management and those who may be seeking the drugs for other purposes?
The Prescription Monitoring Program (PMP), a national database of all prescriptions filled for controlled substances, was created in 2002 in response to the opioid crisis. Drs. Alberts, Evans and Hall indicate that they and their medical partners always search the PMP prior to prescribing any opioid, to be sure that their patients have not received opioid medications from other physicians or facilities. In Dr. Evans’ practice, patients also undergo a urine drug-screening test to ensure that they are not using other prescription or illicit substances that put them at increased risk of unintentional overdose.
“For patients we suspect of having an addiction who are requesting more pain meds, we simply don’t prescribe opioids,” adds Dr. Alberts.
Safety is an Important Part of the Caring Tradition
While opioids can offer benefits to patients with acute or chronic pain, it’s important for patients to understand the potential dangers of these medications and the risks of long-term use. Sentara Martha Jefferson’s providers are dedicated to delivering the best care, while keeping patients safe.