Physician urges colleagues to do more to prevent opiate dependency
Dr. Dan Doyle speaking with a pharmacist at the New River Health Pharmacy.
October 26, 2012 ·
West Virginians fill an average of almost 19 prescriptions per person annually while the national rate is only 12. One doctor says physicians should look to alternatives rather than opiates, to address complaints from patients.
“One of the big challenges for us as primary care physicians," Dr. Dan Doyle said, "is to make sure that we are not prescribing chronic opiate medications for people who are abusing them or diverting them.
Doyle is a family physician at the New River Health Association in Fayette County.
“We have to constantly be alert and pay attention to red flags that can alert us to abuse or diversion.”
In Southern West Virginia, many people earn a living doing manual labor such as timbering or coal mining and that adds to the volume of patients in need of pain medicine.
“We do see a lot of injuries," he said, "muscular skeletal injuries, neck injuries, back injuries, shoulder injuries, knee injuries, fractures.”
“So people have acute pain that can go on few weeks. Many times they are not able to go back to work in three or four or six weeks. They’re still having pain. They have other issues going on in terms of bills and stresses and so for those patients it’s very easy to become dependent.”
Doyle says many times patients don’t realize they are reaching out for physical pain medication to treat emotional pain. And he fears that too many doctors are not looking for an alternatives.
“I am really concerned that a very high percentage of the opiate pain medication that’s being prescribed in our state chronically," he said, "is being prescribed more for people who have become dependent on the medication than actually for chronic pain.”
“It’s very difficult for the patient to tell the difference between opiate defendants and physical muscular skeletal pain. Pain is pain for the person who has it.”
“I am concerned that a huge proportion of the opiate prescribing that’s going on is due to iatrogenic opiate dependents and I definitely think that we primary care physicians need to be more careful about prolonged use of chronic opiates in muscular skeletal pain and injuries.”
An important guideline that Doyle says he tries to follow, is no chronic daily opiates 8 weeks from an injury. He admits as a physician, it’s tough to stick to.
“People are still feeling pain and depression and discouragement and it’s hard to get off those medicines," he said. "Your brain notices that they’re gone and complains. Your brain is screaming 'hey where‘s my Percocet' and so people interpret that as pain."
Doyle says patients need to be aware of the medicine’s limitations. And he thinks it’s partly the physician’s responsibility to monitor the situation more carefully and not automatically prescribe addictive narcotics to their patients.
“Many times they come to us asking for help and all we can think of is to give them more medicine," he said.
"They consider that they need that they want that and that starts a vicious cycle going on and in many ways that involves us the doctors and the patients in terms of more and more medication dependents without the person necessarily getting better in terms of their mood in terms of their function getting back to work or often even in terms of their pain.”
Doyle says explaining the limitations are not always easy.
“Physicians are very, very busy," he said. "We’re hurried we’re rushed and unfortunately and also people are watching ads on TV at night that tells them about new medications that come out so we’re bombarded with requests for medicine and it’s really hard for us to take 20 minutes to talk to a person about the alternatives than to basically take five minutes to write the prescription they’re asking for.”
Rather than writing a prescription, Doyle says he might suggest other means of managing pain such as physical therapy, more exercise, or evaluating bad habits.
“A lot of times more medicine isn’t the answer. And yet for the allopathic MD physicians," he said, "sometimes we feel kind of boxed in that the only options we have are physical therapy, surgery or drugs.”
Doyle hopes he and other doctors can help address the problem by finding the time to talk to patients about alternatives to narcotic medication and thinking outside the box by prescribing other therapies.