More mountain doctors cutting back on painkiller prescriptions
WLOS Asheville —
Making the Change
Your next trip to the doctor may not include a trip to the pharmacy for pain medication.
A News 13 investigation dug into the amount of painkillers prescribed in the mountains and how several local hospitals are trying to break a decade-long cycle of addictions.
It’s an effort to keep patients from developing a dependency in the first place.
From the VA Health System nationwide, to one Henderson County hospital, many are taking a closer look at prescribing numbers and has many doctors changing how often they're pulling out their prescription pad.
Three days a week, Paula Arriaga is at Ascending Fitness working out with owner Jim Frith. She hopes it strengthens her muscles and eases her back pains, but lifting what pains this former Air Force Reserve Sergeant isn't easy.
“I have quite a bit of pain after doing certain things, some twisting exercises," Arriaga said.
A motorcycle crash left two metal rods in her spine.
“Parts of the bone splintered into the spinal cord, and so I was very unstable,” Arriaga explained.
Recent pelvic and ankle surgery added up to a decade of narcotic painkillers. Then Paula's doctor used a term a week ago -- one Paula doesn't agree with -- that's left her bruised.
“She said, 'You know you're an addict. We have to get you off of this.' I felt hurt by that, and I've asked myself this whole time, 'What do I need to do?” questioned Arriaga.
Having the Conversation
It's a conversation more doctors are having with patients, including Dr. Scott Donaldson of Henderson County. Donaldson's trying to change a culture that's destroyed lives by prescribing fewer opioids.
“You don't say, 'I'm not going to treat your pain.' What you say is, 'I'm going to give you something that's non-narcotic because narcotics will ruin you',” Donaldson said.
“In my personal practice, I've gone to almost zero narcotics. Not completely, but I'm approaching zero very quickly," Donaldson added.
He’s also pushing the practice at Pardee UNC Health Care, where he's Chief of Staff. Beside Chief Medical Officer Dr. David Ellis, they're encouraging doctors to know their opioid prescribing numbers and cut back.
“That's 7.8 million pills in Henderson County (in 2016). What do you think it is in Buncombe County?” Dr. Ellis questioned.
News 13 tracked down the numbers at the Department of Health and Human Services. Records show it’s 16.1 million pills in Buncombe County and 5.3 million pills passed over pharmacy counters in Haywood County. There was little change from the year before.
But the Substance Abuse and Mental Health Services Administration argues fewer prescriptions nationwide haven't amounted to fewer deaths. They say 50 percent of people addicted get pain pills from someone else with a prescription.
Pardee doctors are aware of the issues with leftover opioid medication. They support what’s called a Deterra bag. The hospital gave these to 150 outpatient surgery patients to dispose of leftover opioids. They're easy to use: Fill it with water, add pills, shake and toss it. The left over pills are destroyed and safe to throw in household garbage.
Pardee then followed up, calling patients after handing out the bags. What they found was, over and over, doctors prescribed too many pills.
“People had probably about a third of the narcotics left over,” Dr. Ellis said.
When News 13 questioned if that was too much, Ellis said, “I would say it's too much. I mean there's nothing wrong with a patient calling up and getting another prescription for pain medication if they need it."
Dr. Donaldson's showing "tough love" to his colleagues and plans to keep talking about the issue at staff meetings.
“My goal is to have this conversation at every one of these meetings until people are sick of hearing about it, until my colleagues are sick of hearing about it from me,” Donaldson said.
But Donaldson’s also continuing a deeper conversation with his patients.
“I tell them all the time, 'I'm not your friend here. I'm your advocate. Your friend is going to give you the Percs. I'm going to tell you what you need and don't need',” Donaldson said.
Making the Change
Since Memorial Day, Paula's trying it her VA doctor's way with a lesser dose of painkillers.
“I got my next prescription and it was only half full,” Arriaga said.
Now she’s snapping pills in half, but it’s also cut in half the time she can spend doing some of her favorite activities.
“I want to be active with my three dogs who love to walk, but I haven't been able to walk very much,” Arriaga said.
As a medical professional herself, she doesn't disagree opioids have become a national crisis.
“We should do all we can to keep patients off of narcotics, but for some people that has, it should be used,” Arriaga said.
But Arriaga’s skeptical about being pulled or pushed toward medication that differs from what's worked.
“I am definitely willing to, and they're really willing to work with me and make sure my prescription will be continuing until whatever point we are, where we get to,” Arriaga said.
Last April, North Carolina launched its Safe Opioid Prescribing Initiative, investigating doctors who prescribe a high daily dose of opioids and have had two patients die from opioids related poisonings in a 12-month period. The state has opened 62 cases, with 19 unfavorable reactions. Recently a Morganton doctor was reprimanded for over prescribing according to state Medical Board records.
Pardee Hospital plans to make Deterra bags available at a patient’s next post-operative visit.
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Here's more information about the VA Health System's policy:
The Department of Veterans Affairs (VA) has initiated a multi-faceted approach to reduce the use of opioids among America’s Veterans using VA health care. The Opioid Safety Initiative (OSI) is a comprehensive effort to improve the quality of life for the hundreds of thousands of Veterans suffering from chronic pain.
Launched in October 2013 in Minneapolis, Minnesota, OSI is already demonstrating success in lowering dependency on this class of drugs. At eight sites of care in Minnesota, OSI practices have decreased high-dose opioid use by more than 50 percent. OSI incorporates the team approach with the goal of reducing opioid use by alleviating a Veterans’ pain using non-prescription methods. There is an emphasis on patient education, close patient monitoring with frequent feedback and Complementary and Alternative Medicine practices like acupuncture.
“We have developed and implemented joint pain management guidelines which encourage the use of other medications and therapies in lieu of habit forming opiates,” said Secretary of Veterans Affairs Eric K. Shinseki. “Early results give us hope that we can reduce the use of opioids for Veterans suffering with chronic pain and share these best practices across our healthcare networks.”
The Opioid Safety Initiative faces the challenge of opioid dependency with an innovative and comprehensive plan that closely monitors VA’s dispensing practices system-wide and coordinates pain management to include patient and provider education, testing and tapering programs, and alternative therapies like acupuncture and behavior therapy.
Veterans enrolled in the VA health care system suffer from high rates of chronic pain. Each VA facility employs personnel including Interdisciplinary Pain Medicine Specialty Teams and Consult Services, Facility Pain Committees, Pharmacy staff and Primary Care/PACT, and other professionals to accomplish the goals and objectives of the OSI.
VA has developed patient management initiatives including Pain Coach, which is a pain management app available for download by patients receiving pain management treatments, a Veterans’ Health Library, including a Patient/Family Management Toolkit, and resources for Pain Management on My HealtheVet. All of these applications allow Veterans to better manage their pain without the use of opioids. VA‘s measurement-based pain care includes the “Pain Scale,” which reduces uncertainty and helps Veterans by discussing the potential benefits of a medication and possible side-effects.
“The Opioid Safety Initiative is an example of VHA’s personalized, proactive and patient-centered approach to health care. We are also using a full-range of support treatments for Veterans, including Complementary and Alternative Medicine ,” said Dr. Robert Petzel, VA’s Under Secretary for Health. “We are delivering health care with the patient’s long-term personal health goals at the forefront.”
For further information, veterans should contact their primary care health team. To learn more about VA health care, visit www.va.gov.