Shamokin doctors OK with new opioid rules
SHAMOKIN - Two Shamokin area doctors say new guidelines for prescribing opioids for chronic pain will not have any effect on how they practice because the prescriptions they write already fit the criteria
The guidelines, crafted by the Pennsylvania Medical Society (PAMED) in May and announced July 10, establish a pattern of behaviors for doctors to follow when prescribing opiates to relieve pain for conditions that will not quickly be resolved.
Behaviors include discussing the risk of addiction with the patient, assessing the patient's history for addiction risk, using non-opioid analgesics whenever possible, watching for aberrant drug-related behaviors and engaging the patient in pain-reducing therapies.
"It sounds like common sense things that we should all be practicing," said Dr. Wayne Miller, an internist who operates a private practice on Spruce Street.
Dr. Samuel Slimmer, associate director of the emergency
medicine residency program at Geisinger Health System, who works in the emergency room at Geisinger-Shamokin Area Community Hospital several times per month, agreed.
"It really doesn't change much for me," said Slimmer. "Most of the primary care physicians and emergency room physicians (at Geisinger) have already been doing this."
The chemicals that make up prescription opioids are almost identical to those of the drug heroin, and can cause the same high and dependency. Addicts will sometimes attempt to get a prescription for an opioid painkiller like OxyContin by claiming chronic pain, or by purchasing the painkillers from someone with a prescription.
The PAMED guidelines are not the first attempt to curb the misuse of opioid painkillers; as the number of prescription opiate overdoses has jumped from 4,000 in 1999 to 15,000 in 2010, more physicians organizations are setting standards designed to avoid patients overprescribing these highly addictive drugs.
Miller said a push to prescribe more painkillers came approximately 10 to 15 years ago when doctors were told that they were not treating pain well enough.
"There were reports that doctors were falling short in managing pain, so we became more likely to treat pain aggressively," said Miller.
In the last five to 10 years, as abuse of painkillers has become more prominent, Miller has seen the reversal of this trend, but is aware that some doctors in the area are still keen to prescribe opiates.
"There's a spectrum of physicians in our community that vary on how easily they prescribe opiates," said Miller. "It seems people in the community know who those doctors are (that prescribe more easily) and take advantage of that."
Slimmer occasionally sees patients who have come to the emergency room seeking treatment for an increase in chronic pain. He said he can often find better long-term solutions for these patients, like surgery to repair a slipped disk or the use of nerve blocker.
"The whole goal is to minimize the use of opiate narcotics," said Slimmer.
Miller said sometimes patients who have a legitimate need for an opioid painkiller are hesitant to use one for fear of addiction. He said these types of people, and people with a genuine need for a strong, short-term painkiller, are highly unlikely to become addicts.
"Like most things in life, when done appropriately, things go well," he said. "Rarely it's the patient that begins narcotic use for legitimate reasons that continues for inappropriate reasons."