From the Desk of Dr. Lasich

A recent trip to the Harvard pain medicine conference was very stimulating and invigorating. Besides learning a great deal of information about the latest treatments for a variety of painful conditions, I enjoyed being surrounded by an audience of colleagues that came from all parts of the world. We were all there to learn from the best about what pain medicine has to offer and we were not disappointed.

The future of pain medicine is in our hands. And we are all learning from past mistakes. Now, we know the serious consequences from long-term opioid use like bone loss. Now, we know that some vitamins really do prevent pain. Now, we are slightly more suspicious of everyone.

Read further, to learn about the future of pain medicine and different ways to look at common problems like bone loss, nutrition and vitamins deficiencies.

Lessons from the Past Prepare Pain Medicine for the Future
by Christina Lasich, M.D.

To err is human, but failure to learn from mistakes is foolish. Many mistakes have been made when it comes to treating pain and the future of pain medicine hinges on whether or not we can learn from these mistakes. The dismal lack of education and knowledge among healthcare professionals and the public has really amounted to a huge number of mistakes, some deadly. Between 1999 and 2007, drug-induced deaths were second only to motor vehicle accidents.1 Since the early 1990’s, the rate of unintentional drug overdoses has dramatically risen in conjunction with the dramatically increasing number of opioid prescriptions.2 Other mistakes may have been more insidious because greed and addiction have hooked many. The results can be just as deadly as we have all seen in the high profile cases splattered across the headlines about Anna Nicole Smith and Michael Jackson. These big names overshadow the millions of lesser known victims out there among the youth of America who have gotten a taste for pills found in unlocked medicine cabinets, trash bins or in the pockets of “friends”. Now, the future of pain medicine is precariously perched at the edge of a cliff unless we can all learn from our mistakes.

Dealing with the pain epidemic is extremely difficult when America is also caught in the crosshairs of a prescription drug abuse epidemic. Public health officials like the Surgeon General know that the key to successfully stopping any epidemic is education. Education has helped solve many public health crises. With the recent White House report released called “Epidemic: Response to America’s Prescription Drug Abuse Crisis”, this administration has launched a strategy to deal with the prescription drug abuse epidemic, but whether or not this plan will undermine the current war against pain is yet to be determined.

The first strategic arm of this plan addresses the lack of education in the current population of medical care professionals surrounding the treatment of pain and the risks of prescription drug use. This call for action will not only help to address the pain epidemic, but should also help to curtail the substance abuse epidemic. Health providers will be educated about risk assessment, outcome monitoring, and the standard of care for those in pain. According to Scott Fishman, MD, president and chair of the American Pain Foundation, physicians will be asked to participate in “16 hours of medical education and a test about the treatment of pain”. Dr. Fishman’s home state of California already has a law (AB487) that requires most doctors to complete 12 hours of pain medicine or palliative care education. The entire nation will be moving in that same direction because as Dr. Fishman says, “The time to address the lack of education in the current doctor population has come.”

Educating health care professionals is just the beginning. The general public, parents, law enforcement officers and children are all targets of a larger education process which aims to curtail the prescription drug abuse in America. In addition to a public health education campaign, the government is encouraging research into new technologies to combat drug abuse. Although the pharmaceutical industry is developing more “abuse deterrent medications” that cannot be tampered with and injected, this technology may give doctors and the public a false sense of security. According to Dr. Carol Warfield, FDA consultant and Harvard Professor, “Shooting-up is not the primary way that kids are using these drugs. Many are going to parties and taking the pills orally. These tamper-proof drugs are not necessarily a real abuse deterrent.”

On the other hand, one piece of technology has made a real dent in the drug abuse problem. The prescription drug monitoring programs (PDMP’s) available in 27 states has slowed down the abuse/misuse rates in those states. Because of this success, the President’s Action Plan also calls for all 50 states to start offering PDMP’s within the next 36 months. The VA and other government agencies will also start participating in the monitoring programs. Dr. Fishman predicts that the state medical boards will become more involved with monitoring who is using the PDMP’s and who is not. Eventually, America will be cast in a network of prescription drug monitoring in an effort to stop the doctor shopping, the drug diversion, and other problems like the “OxyContin Express”.

As many are already aware, the “pill mills” are being shut down in all 50 states as a direct result of this administration’s priority to stop the prescription drug abuse epidemic. Law enforcement agencies have been asked to “continue aggressive enforcement actions against pain clinics and prescribers who are not prescribing within the usual course of practice and not for legitimate medical purposes.” Officers are not shutting down clinics that are making simple, innocent mistakes. No, many doctors who are losing their licenses are examples of how greed has lead to the blossoming of “pill mills”. One enterprising doctor was actually operating out of Starbuck’s according to Dr. Fishman. This doctor was eventually caught by undercover DEA agents. Unfortunately, these greedy few are jeopardizing everyone’s ability to deal with the pain epidemic.

And therein lies America’s biggest problem, we have a two sided coin. On one side of the coin, we have the pain epidemic. On the other side of the coin, we have the prescription drug abuse epidemic. Flip the coin to solve the problem and you can only come up with one side or the other. Heads or tails? Pain or drug abuse; which epidemic should have the priority? Education has the potential to solve both sides of this coin problem. But, education can only go so far as we have seen with the AIDs epidemic and the obesity epidemic. Electronic and pharmaceutical technology will help the abuse problem to a certain extent, but may also give a false sense of security. Law enforcement actions are the least desirable actions because ultimately those actions cause fear among doctors and patients. The future of pain medicine is a source of worry for both doctors and patients alike for we are all only human and admittedly have made mistakes. But, we are not all fools. So, many are learning from these lessons of the past and preparing for the future of pain medicine. Judging by the recent call for action, the future of pain medicine promises to look very different than the past two decades.

Sources:

  1. National Center for Health Statistics, Centers for Disease Control and Prevention. National Vital Statistics Reports Deaths: Final Data for the years 1999 to 2007

  2. Centers for Disease Control and Prevention. Unintentional Drug Poisoning in the United States (July 2010)

LIFE Quotes

“Communication is only sometimes within our range of hearing”
– Inside of a Dog by Alexandra Horowitz

Dr. L at Health Central

Apothecary Corner

Ibuprofen interferes with the cardiovascular protective mechanism of aspirin.