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You just had your wisdom teeth surgically removed, and your dentist gives you a prescription for Vicodin to be taken as needed for pain. You take it because you’re afraid of the pain you’ll feel if you don’t. It has been two weeks now, and you just ran out of your Vicodin. You need more. Not because you are in pain, but because it makes you feel good. You don’t really need it, but you want it.
You call to ask for a refill of your medication, and you get it. You’re fully functioning at work and home, and do not think it is a problem, until it is. As the highly functioning mother, teacher, executive or student, you do not think it can happen to you, until it does.
Pain was first recognized as the fifth vital sign in the 1990s, giving pain equal status with blood pressure, heart rate, respiratory rate and temperature as vital signs. This has fallen out of favor, as there is not a physical way of measuring pain. There are obviously differences between acute pains after a procedure such as wisdom teeth extraction versus chronic pain for longer than three months, maybe due to chronic degenerative arthritis. There is a completely different category of pain that is related to cancer treatment, palliative care or end-of-life care.
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Opioids are a class of drugs that include the illicit drug heroin as well as the prescription pain-relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others. Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
It becomes a problem when the pattern of opioid use leads to impairment or distress. This is marked by unsuccessful efforts to cut down or control use, resulting in social problems and a failure to fulfill major role obligations at work, school or home. Having a history of a prescription for an opioid pain medication increases the risk for overdose and opioid use disorder. U.S. health care costs attributable to the abuse of prescription painkillers in Washington state is $977 million.
In May 2016, rapper Macklemore appeared in President Barack Obama’s weekly address to discuss the epidemic of opioid addiction in the United States. In the past decade, while the rates for the top leading causes of death such as heart disease and cancer have decreased substantially, the death rate associated with opioid pain medication has increased markedly. During the year 2011-2013, there was a 21 percent increase in opiate-related deaths compared with 2002-2004.
Due to this nationwide problem, many organizations including the Centers for Disease Control and the Washington Department of Health have adopted rules concerning the management of chronic noncancer related pain. Most states such as Washington have a Prescription Monitoring Program that collect all the records for Schedule II-V drugs and made them available for viewing.
As a provider who went into medicine to prevent pain and “do no harm,” it is not easy to treat opioid addiction and chronic pain.
As a human who can empathize while listening to distressed stories about living with pain, the easy thing would be to give a pill and make it go away, even temporarily.
Doing the right thing should not be this hard. Establishing a plan around mutual respect and trust is the foundation. Just like many strong relationships, there has to be engagement.
Providers and patients on chronic opioid therapy can become a powerful team with common goals. The solution lies with informing both patients and providers about how to safely prescribe and use prescription narcotics. At the end of the day, the hard and dreaded conversations can save a life.
Lan Nguyen, a primary care physician, is a member of The Olympian's 2016 Board of Contributors. She may be reached via firstname.lastname@example.org