Solutions, Not Blame

April 9, 2012 2:34 pm Leave a Comment

When tragedy strikes from prescription-drug related harm and a loved one is lost, the devastation remains forever. The desire to blame physicians who treat chronic pain is understandable but cannot solve the problem. Unfortunately, there isn’t one solution, such as restricting the use of opioids to people with severe rather than moderate-to-severe pain, as suggested in a recent Salem-News.com article.  Such a move has the potential to create more tragedy.

For those who have suffered the loss of a loved one from prescription drugs, it may be difficult to accept that people also die from inadequately treated pain.  The agony is no less when someone is lost to suicide because he or she could no longer take the pain and isolation of a chronic condition without a solution.

We who treat patients with pain certainly need to do a better job of identifying who should receive these medications and who should not. However, people who use opioids for nonmedical purposes will still find them, even if they are limited to people with the most severe pain problems. An unintended result would be that patients who benefit from opioids and never abuse them are left to suffer needlessly without their medication.

See how blaming doesn’t solve problems? Science is slow, and funding is never adequate for the many studies that are needed. But progress is happening, even though the steps are small. New research shows how people differ genetically in opioid response, raising hope that opioid responders can be identified early. Newer, safer non-opioid therapies are on the horizon. Recently published research that points the way to safer methods of switching between opioids may save thousands of lives. Lives that might otherwise have been lost to the scourge of chronic pain.

Filed Under: Pain Medication Abuse

ABC Twitter Chat on Chronic Pain

February 20, 2012 2:04 pm Leave a Comment

Tomorrow, Tuesday, February 21, 2012, ABC’s Chief Health & Medical Editor, Dr. Richard Besser, will be leading a Twitter Chat on chronic pain.  Dr. Lynn Webster (President, LifeSource) will be participating as a representative of the American Academy of Pain Medicine (AAPM).  The chat will be from 1 – 2 pm ET, and we will be using the hashtag #ABCDrBchat . Follow Dr. Webster (@LynnRWebsterMD) and follow along then to participate!

 

Filed Under: Pain Medication Abuse Tagged With:

Whitney Houston and Drug Overdose-Related Deaths

February 13, 2012 10:44 am 3 Comments

I don’t know if we will hear that Whitney’s death is a drug-related death, but based upon her troubled past, it is a possibility.  I am not a big music buff or a celebrity follower, but I am touched by the humanity of the tragedy and the sadness within the greatness of people like her.  I am saddened that she must have felt alone, isolated, and in despair.

It isn’t that she was talented that made her death so impactful for me, but that she gave so much to others through her gift of music and yet must have struggled for a meaningful life.  My patients have similar lives.  They exist but don’t live.  They seek to be alive but hit walls and are isolated.  They want to be heard but there is silence.   If our hearts and minds were more open we could do more healing and, just possibly, save more lives.

Filed Under: Drug Overdose, Pain Medication Abuse Tagged With: ,

Community Anti-Drug Coalitions of America Conference – Day 1

February 6, 2012 10:56 pm Leave a Comment

Today kicked off the Community Anti-Drug Coalitions of America (CADCA) 2012 National Leadership Forum in National Harbor, Maryland.  Today was also the Substance Abuse & Mental Health Services Administration’s (SAMHSA) Annual Prevention Day.  Those in attendance were fortunate enough to hear from some excellent speakers, including:

  • Mirtha Beadle, Deputy Administrator for Operations, SAMHSA
  • Louisa F. Teo Tuiteleleapaga, Assistant Director, Department of Human & Social Services, American Samoa Government
  • Carole Justice, Project Coordinator, Indian Country Methamphetamine
    Initiative Project
  • Karen S. Moses, Director, Wellness Health Promotion, ASU Wellness, Arizona State University
  • Jeff Rindler, Managing Director, Program Services & Evaluation
  • Greg Wallace, Project Director, The HEROES Initiative, Johnson City Schools, State of Tennessee
  • Frances M Harding, Director, Center for Substance Abuse Prevention, SAMHSA
  • Rear Admiral Peter Delany, Director, Center for Behavioral Health Statistics and Quality, SAMHSA
  • Paolo del Vecchio, Acting Director, Center for Mental Health Services, SAMHSA
  • H. Westley Clark, Director, Center for Substance Abuse Treatment, SAMHSA
  • Keynote: Inge Missmahl, Analytical Psychologist and Founder, International Psychosocial Organisation and Project Kabul for Caritas Germany
  • Colonel Grant Olbrich, Operations Officer, Behavioral Health Branch, Marine Corps Headquarters, Division of Marine & Family Resources
  • Gregory Goldstein, Future Operations Officer, Behavioral Health Branch, Marine Corps Headquarters, Division of Marine & Family Resources
  • Todd Park, Chief Technology Officer, U.S. Department of Health & Human Services
  • Kana Enomoto, Principal Deputy Administrator, SAMHSA
  • Arthur T. Dean, Chief Executive Officer, Community Anti-Drug Coalitions of America

In addition to the keynote address and plenary sessions, there were two workshop sessions today.  I wanted to take a moment to give a quick update about some interesting ideas that I learned from a workshop entitled “Prescription Drug Abuse: Understanding and Addressing the Problem at the Federal, State and Local Levels.”

The first portion of the workshop was used to define prescription drug abuse, and to demonstrate that medical and non-medical prescription drug abuse is increasing in the United States.  While the data presented was interesting, the ideas that stood out to me came from actual coalition leaders discussing strategies that they have implemented in their communities, and these are the details that I would like to share today.

The first coalition that presented their ideas was the Aroostook Substance Abuse Prevention (ASAP) Coalition, based out of the Aroostook County, Maine community.  This coalition has implemented a strategy with the goal of reducing the amount of prescription drugs diverted from legitimate use for sale, distribution and abuse.  Every month, ASAP sends a diversion alert to the physicians in the community detailing all drug arrests made the prior month.  The alert contains the following information:

  • Image of the arrested
  • First & last name
  • Date of birth
  • Sex
  • Community
  • Offense
  • Drug
  • Date
  • Source (ie Sherriff’s Department, Caribou PD, etc)

As stated by the coalition director, Clare Desrosiers, MSW, the initial objectives were to:

  • Increase health care provider awareness of the problem of prescription drug abuse/diversion
  • Increase health care provider awareness of patients who may be diverting or abusing prescriptions

The most impactful result of these monthly Diversion Alerts is the inability of individuals in this community to “doctor shop,” which refers to the practice of a patient requesting care from multiple physicians, often simultaneously, without making efforts to coordinate care or informing the physicians of the multiple caregivers.  This is a common technique used by those patients who frequently divert prescription medication for nonmedical use.

While the information was being presented, my first thought was that these Diversion Alerts would violate HIPAA regulations or at the very least some kind of local or state privacy laws.  Upon questioning, Ms. Desrosiers pointed out that, according to Maine statute, “data can be distributed to the public once the person has been charged with a crime.”  Furthermore, “conviction data can be available on an ongoing basis as it is a permanent public record.”

While this strategy has proven effective, we also heard from Keleigh Taylor with the West Virginia Department of Health and Human Resources Bureau of Behavioral Health and Health Facilities.  While Ms. Taylor presented a number of great concepts, there was one focus that stood out as unique and particularly effective.

The first part of Ms. Taylor’s plan started with a presentation that was given at the Eastern West Virginia Homebuilders Association.  The presentation focused on placing “medicine cabinets” back in the basic homebuilder’s package.  Most modern homes are not designed to include a traditional medicine cabinet in a bathroom, mostly because of aesthetic reasons.  Ms. Taylor’s group advocates that either this ‘design flaw’ should be reconsidered, or that there should be an alternative.

The alternative seemed to me to be a very effective solution.  In working with the Eastern West Virginia Homebuilder’s Association, Ms. Taylor’s group was able to negotiate a simple plan.  For those families that do not wish to have a traditional medicine cabinet in their restroom, the group was able to offer a subsidized secondary option.  Many families keep prescription and over-the-counter medications in a kitchen cabinet, so this group is able to offer a homebuilder the option to have one locking kitchen cabinet that can be safely used to store medications (out of the reach of children and/or guests).  Installing one lock is relatively inexpensive and offers families a more aesthetic option than the tradition medicine cabinet.

As the second part of Ms. Taylor’s plan, her group was able to meet with the Eastern West Virginia Realtors Association to discuss the importance of speaking to their clients about locking up their prescription medications during open houses.  This is a very simple precaution that is overlooked more often than not, but with some very simple education and reminders, many instances of theft and eventual overdose can be prevented.

These are just the highlights of what was an incredible day of learning about substance abuse prevention.  As the Leadership Forum progresses through the week, I will be posting additional blog posts to share with you what I have learned.  Also don’t forget to “like” us on Facebook (www.facebook.com/yourlifesource) and “Follow” us on Twitter (@yourlifesource) to get real-time updates about various sessions and speakers throughout the week.

Thanks for reading!

 

Filed Under: Drug Overdose, Opioids, Pain Medication Abuse, Substance Abuse Tagged With: , , ,

Inagural Post

January 3, 2012 10:57 am 2 Comments

Welcome to my blog!

As we start a new year I want express my thanks to everyone who takes the time to read this inaugural blog.

The intent of this blog is to be informative and provide you, the reader, insight about timely health care issues. Initially I will focus on two public health challenges: prescription drug abuse and chronic pain.

Everyone who reads a newspaper or magazine is aware of the dramatic increase in the number of individuals who have been harmed by prescription medications.  I have spent considerable time and effort addressing this issue, and it this reason why the LifeSource Foundation was established.  Our focus will remain on preventing harm from prescription medications, but I also want to be sure those who can benefit from all types of pain therapies have appropriate access to them.

It is less well known that there are far more people who suffer from intractable pain than who are harmed from prescription medications.  This does not mean that we should accept the level of harm that exists today.  There are tragedies occurring every day that can be prevented.

On the surface it might seem that these two serious public health problems would have conflicting goals.   This is not true.  It is easy to set up a dichotomous choice, but that would be inappropriate and shallow thinking.

The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. Acting through the National Institutes of Health (NIH), HHS asked the IOM to assess the state of the science regarding pain research, care, and education and to make recommendations to advance the field.

They reported that over 100 million Americans experience chronic pain.  This is one of every three Americans!!  Nearly every American will know at least one person who has chronic pain.  It is even more likely that every American will experience chronic pain in their life.  The report suggests that many of these individuals are or will struggle to find access to care.  No other medical problem affects as many people or is more personal than the problem of pain.

The IOM declared that a cultural transformation is needed to better prevent, assess, treat, and understand pain.  The problem of prescription drug abuse also will require a cultural transformation to reverse the trend of overdoses deaths and abuse.

Here in lies the two major health care challenges of our time.

One of the mainstays of therapy for moderate to severe pain has been opioid therapy.  For many individuals, this is the only treatment that provides relief. Nothing else is as effective.  While there are many physicians, regulators and other interested parties who contest to this notion, there are some who believe opioids should not be used for chronic pain regardless of the severity of pain.

In the last 12 years the amount of opioids prescribed has dramatically increased. Yet it is unclear how this has contributed to the harm that has also occurred during this time.

An important first step in reversing the trend of prescription drug abuse and overdose deaths is for better prescriber education.  Another is for the public and patients to be more cognizant of the potential harm from these drugs if they aren’t used as directed.  I will be writing more about these issues in future blog posts.

Again, thank you for reading my inaugural blog post.  Please be sure to check back soon for more posts, and don’t forget to share your stories, comments and experiences!

Lynn Webster, MD
President & Co-Founder
LifeSource

Filed Under: Pain Medication Abuse Tagged With: ,