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The Exchange

In Opioid Crisis, Doctors Struggling to Balance Addiction Concerns & Pain Management

NHPR File Photo

The opioid crisis has forced physicians to rethink their prescribing practices, and many are providing fewer opioid prescriptions, potentially leaving some patients without proper pain management.

Tighter regulations and insurance requirements have reduced overprescribing, but many say this makes it difficult for patients with both acute and chronic pain to find the help they need.

The Exchange looked at how physicians balance prescribing opioids safely and responsibly with increased pressure to reduce opioid abuse.   

Dr. David Nagel, a physician who specializes in pain management at Concord Orthopedics, said there’s a “third public health crisis” in the United States: Patients who had been successfully managing their chronic pain with long-term opiate use are now having their prescriptions reduced or not renewed at all as a result of the opioid epidemic.

“I have a text from a patient today that says, ‘Why are we being made to blame? Why are we being blamed for all of these other issues when we were doing fine and following the rules?’” said Nagel.

Dr. Richard Barth, Professor of Surgery at Dartmouth’s Geisel School of Medicine and Chief of General Surgery at Dartmouth-Hitchcock Medical Center, said physicians must consider the welfare of the public at large, as well as their patients.

“We can't just keep prescribing boatloads of opioids for patients when diversion is happening, and when we have 42,000 people dying every year in the United States from opioid overdoses,” Barth said. “We can't ignore the public health issue anymore.”

Barth said medical providers around the country continue to seek solutions.

“We're not looking to get rid of opioids,” he said. “We're just looking for them to be appropriately prescribed for patients.”

Michelle Ricco Jonas, program manager for the state's prescription drug monitoring program, said healthcare providers have been struggling to navigate the complicated regulatory landscape surrounding opioid medications – and that has led to some hesitation and confusion.

“I'm not sure if it's fear. I think there's confusion at least,” she said. “I think there's got to be more education and a better understanding of the rules, because I think (medical providers’) interpretation sometimes wavers a little bit.”

Ricco Jonas said she hears from patients who are having a hard time finding a doctor willing to prescribe opioid medications.

“Oftentimes we get the same kind of comments: ‘My doctor says they can't prescribe anymore because of the opioid rules and the way the rules are written,’ “she said.  “And if you actually read them, they're not written that way at all. So I question sometimes if they've actually read them.”

Ricco Jones said the prescription drug monitoring program, adopted by the legislature in 2012, has addressed some of the problems identified in a 2017 audit.

“I think many in the legislature agreed with us that the prescription drug monitoring program, when it was enacted, wasn't really given the resources it needed,” she said.

Ricco Jonas said she hopes to hire an analyst by July 1 and will then aim to hire someone focused on ensuring provider compliance. 

To learn more about issues surrounding opioid prescription in the current abuse epidemic, listen to the full conversation here

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