How Primary Care Doctors Can Help Fight Opioid Addiction in the US


09.03.2019

The news cycle is churning faster than ever. With so many headlines spanning so many topics out there, it’s rare that any particular story stays on our radars for more than a few days. But there are a few exceptions. Perhaps the most prominent health headline these days is about the opioid epidemic in the US.

The Centers for Disease Control and Prevention (CDC) reports more than 42,000 people died from opioid overdoses in 2016. Of these fatalities, 40 percent involve prescription opioids. These numbers are harrowing, particularly when you consider that so many of these medications are prescribed with the intention of helping patients.

While some have taken to casting blame on doctors, it’s important to remember that physicians are also part of the solution. Scores of providers are already helping to solve the problem. In fact, primary care physicians can do quite a lot to help fight opioid addiction. Keep reading to learn about some of the actions these everyday health care heroes are taking.

What can primary care physicians do to help combat opioid addiction?

Primary care doctors can help stem the opioid problem by preventing it in the first place, as well as helping patients who’ve already crossed over into misuse. We spoke with Dr. Kavita Sharma, a pain management physician at Manhattan Pain & Sports Associates who is also board-certified in family medicine, to learn more about how doctors can help.

1. Evaluate each patient individually

Physicians know better than anyone that every patient is unique. All those questions they ask about your medical history and your lifestyle help inform the treatment plan they develop for you, whether it involves prescription opioids or not.

"I also don't think you can say it's safe to prescribe them to everybody."

“I don't think you can blindly say that you're not going to prescribe opioids, but I also don't think you can say it's safe to prescribe them to everybody,” Dr. Sharma explains.

Primary care physicians often determine prescribing opioids is too risky for patients who’ve previously experienced substance abuse. Even a family history of substance abuse is a risk factor. The source and nature of your pain also makes a difference.

“Is this going to be chronic pain? Will they need these opioids forever?” Dr. Sharma recommends physicians ask themselves. “Or is this a patient who has a slipped disk that’s going to be better in six weeks?” Only after thoroughly evaluating the patient and weighing the risks and benefits should a doctor proceed.

2. Try other methods first

Even when a primary care physician doesn’t think a patient is likely to misuse medication, they should rely on other methods before they start thinking about prescription opioids. Most doctors do this already.

"If it's a strain, I recommend that patient first start with physical therapy."

“If it's a strain, I recommend that patient first start with physical therapy,” Dr. Sharma says.

Many patients are able to find relief by maintaining a regular physical therapy routine. You might be surprised how often alternative methods work. Physicians even look to holistic options.

“Depending on the source of the pain, I can often recommend acupuncture or meditation,” Dr. Sharma says. She also mentions anti-inflammatories and other pain medications are options. Some evidence even suggests nonopioid medications are just as effective for managing pain among certain patients.

3. Check the patient’s prescriptions

Let’s say you’ve been seeing your primary care physician to address some sort of pain. You’ve already been through an initial evaluation and have tried some alternative treatment options, but they aren’t helping. Obtaining an opioid prescription might seem like the next step, but good physicians know there’s one final thing they must do.

Dr. Sharma recommends every primary care doctor check their state’s Prescription Drug Monitoring Program (PDMP). Each database collects data on controlled substances dispensed throughout the state. Physicians are granted access to these registries, which allows them to monitor patients.

“You can check online and see what opioid medications a patient’s been using,” Dr. Sharma says. She adds that providers in New York are actually required to check the PDMP before prescribing any type of opioid medication. This helps ensure a patient isn’t obtaining medication from multiple doctors.

4. Be a master of management

In some cases, primary care doctors may determine opioid medications are appropriate for a patient. But treatment doesn’t end with writing the prescription. Any time a physician decides to prescribe opioids, they should be heavily involved in every step of the treatment plan. Patient education is crucial for avoiding opioid addiction.

“We talk about the fact that this is going to be a short-term medication,” Dr. Sharma says, alluding to the fact that opioids are generally only recommended for acute pain.

"We talk about the fact that this is going to be a short-term medication."

Doctors also need to make sure patients attend follow-up appointments, recognize side effects, and know where to find information about how to get rid of unused medication. Physicians should also educate patients about the safest way to take opioids.

“I’ll tell them not to take it in a scheduled fashion,” Dr. Sharma explains. This strategy helps minimize the chance a patient becomes dependent on their medication. As an example, she says you might take one dose on Monday, two on Tuesday, and none on Wednesday.

In the rare case that a physician decides to prescribe opioids to a patient with chronic pain, management is even more critical. The CDC has a pretty specific set of guidelines practitioners would be wise to follow.

5. Offer help to patients who need it

There is always some chance that a patient will ultimately cross the line into opioid misuse. When a primary care physician recognizes a patient has an issue, the best thing they can do talk with them.

“Just have an open and frank conversation,” Dr. Sharma suggests. “Primary care doctors are the best at this because they know the patient and the patient’s family. They should see if there’s any way to wean the patient off the medication on their own first.”

“Primary care doctors are the best at this because they know the patient and the patient’s family."

Physicians try to taper opioids to help minimize withdrawal symptoms, but it can be extremely difficult for patients who’ve misused the medication. Some experts think primary care physicians can do more by pursuing the additional education required to prescribe buprenorphine, a partial-opioid agonist. It can be prescribed as an alternative pain medication, but it’s more commonly used to help control cravings and minimize withdrawal symptoms during detox.

Doctors can also refer individuals to addiction specialists, who can help patients find the support they need. Therapy, whether coupled with medication like buprenorphine or not, can be very beneficial for patients who are misusing opioids.

Doctors who do it all

While the opioid addiction trend we’ve seen over the last few decades is troubling, we have every reason to believe there’s hope for a solution. You can see that primary care physicians are already doing a lot to combat the problem. And that’s just one of the many health issues these practitioners are tackling.

Curious about what else primary care doctors are doing to ensure a healthier world? Learn more about these providers on the frontlines by reading our article “What Does a Primary Care Physician Do? Exploring This High-Demand Medical Career.”

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