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Doctors in Ohio prescribing fewer opioids

MARIETTA — The Ohio Board of Pharmacy released a report this week saying prescriptions for opioids are down for the fifth year in a row.

“We are just trying to shift the pendulum back to more prescribing common sense,” said Cameron McNamee, director of policy and communications for the board. “We’re not in more pain today than we were in the ’80s but there is now more of an expectation that if you’re in pain, take a pill instead of trying physical therapy and other means of increasing function.”

So while the state agency recognizes that the drop in prescriptions doesn’t make the opioid epidemic go away, it decreases further supply for creating future habits.

“If you’re a chronic pain patient, a 90-day supply of solid doses (pills) is a fair amount of medicine,” said McNamee.

And with 568,305,457 individual pills prescribed to Ohio patients in 2017, the number of pills in circulation and available for abuse is still staggering.

“So our system is that anytime prescribers look up patients by name or address they can identify their prescription history through the data required by the pharmacy,” McNamee explained. “The point of the system is to know what your patient is on, to hopefully curb pill shopping.”

In West Virginia, a similar idea is being fielded by the legislature with a proposal to only prescribe three to seven-day scripts for opioids.

On Thursday, the House of Delegates voted 97-1 to approve Senate Bill 273, after making small changes to the Senate version of the bill, which that body must agree to before it goes to West Virginia Gov. Jim Justice for his signature.

CVS pharmacies across the country also implemented a similar program last fall.

Opioid prescriptions for acute pain are limited to seven days at the chain’s locations and chronic pain prescriptions are also monitored through the company’s programs.

But local doctors have mixed views of this required documentation and limiting supply.

Dr. Brian Whalin’s main practice is in Parkersburg, but he also works out of the Quick Care in Marietta. He said the tighter regulation has thrown those in actual pain under the bus with those abusing the system.

“Most doctors now are more than happy to just tell patients no, the state doesn’t allow me to prescribe that, rather than deal with the hassle,” said Whalin. “I don’t have any problem prescribing less but really what we need is better education and access to reliable pain management programs. It is extremely difficult to get a patient into any pain management setting so essentially doctors are given the ultimatum, ‘thou shalt not’ that’s left people out of luck.”

Whalin’s comments were complemented by those of Dr. Jean Hoffman, a chiropractor at Marietta Health and Wellness Center who said the big fight is with insurance companies to cover preventative care.

“We have got to make functional-preventative care more affordable,” she said. “Pain is a signal to tell you something is off balance. We’re trying to get people before they’re in a degenerative process where the only hope is a surgery which 74 percent of the time fails.”

She said preventing further opioid addiction has to be treated holistically, with consideration for the pain history of the individual.

“Someone who has been dealing with years of pain has a higher pain tolerance by the time you put them through surgery,” Hoffman explained. “When you’re post-surgical and have been on pain meds for 20 to 30 years you legitimately need stronger relief for what is now excruciating.”

Juggling addiction in the midst of treatment is another ball in the air to consider, she noted.

“You can chronically use ibuprophen and create problems too, it’s not just the opioids, they will self-medicate and find another way so are you looking at the neurotransmitters for things like serotonin levels too?” she said.

Whalin said the medical community will continue to just “blow smoke” on the issue of addiction until centrally regulated distribution of legal narcotics is implemented nationwide and rehabilitation is affordable and effective.

“Right now the mindset is ‘if I die, I die, at least I’ll be high,'” said Whalin. “To get people to quit dying should be our main focus.”

Dr. Tracy Hendershot, a physician at Camden Clark Medical Center in Parkersburg, said pain must first be defined within the parameters of acute versus chronic.

“Acute episodes should resolve with time, whereas a chronic problem has the added component of the emotional toll,” he said.

For example, an arm fracture would be an acute instance of pain. Bones have broken or tissue has also been torn, but the body is designed to mend itself, Hendershot explained.

“But the goal is to not lose function as a result of the mending process. Fractures heal very quickly but the restriction of the muscle if not (exercised, stretched, conditioned, etc.) can lead to chronic pain and emotional strain,” he said.

He encouraged the use of physical therapy, chiropractors and massage therapy in the healing process from an acute episode, noting Hoffman’s stated goal of maintaining function.

For chronic pain, a bad back or achy knees, he explained that in addition to these strengthening and relaxation measures mental health must be considered.

“We add psychotherapy as well because of the emotional component,” said Hendershot. “It becomes a larger concern because you’re dealing with the loss of function. You’re saying, ‘is this going to be for life, do I have to adapt to this?”

So to add to the aforementioned measures he suggested mindfulness training, counseling and cognitive-behavioral therapy.

“Accepting the correct diagnosis can take a long time,” he concluded.

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