Health Care Officials Say Exit Strategies Could Help Prevent Opioid Addictions

Jul 12, 2016

A new report praises Pennsylvania doctors for their use of opioid-based pain treatments for chronic illnesses, especially cancer.

The report from the American Cancer Society Cancer Action Network comes at time, though, when many legislators and organizations are working to fight opioid addiction.

“When you start talking about cancer patients and the legitimate need and the way that it can change a patient’s life so that they can go back to work and get a decent night’s sleep … you can see light bulbs going off,” said David Woodmansee, the American Cancer Society Cancer Action Network’s director for state and local campaigns. “People are like, ‘Wow, I forgot about that.’ And we have to keep that in mind.”

That tension between the legitimate use of pain killers, like Oxycontin, and the growing addiction epidemic has physicians and addiction treatment specialists thinking ahead and focusing on a patient’s last day on an opioid pain killer.

Mel Phol, medical director of the Recovery Center in Las Vegas, said at a recent conference in Pittsburgh that an exit plan is necessary.

“Nobody would take off in an airplane without a landing gear, right?” Phol asked. “But that is what we do with opioids. We are off and running with no end in sight.”

Exit strategies might be a bit more apparent when it comes to treating pain from bone breaks or cancer treatments, but it can get cloudy when it comes to chronic pain. Phol said once addicted, a person needs more of the pain killer to quell the pain. It’s a cycle: the more you use, the more you need. 

Dean Drosnes, a staff physician at Caron Treatment Center in Wernersville, Pa., said he agrees those with chronic pain, especially, need an exit strategy. He said he sticks to medical literature that says opioid painkillers shouldn’t be used for more than 18 months for non-cancer patients.

“If this isn’t providing you outstanding relief with full return of function and you’re living a really happy, great life at 18 month, we’re done. We’re going to stop this,” Drosnes said. “And even if you ask me not to stop it that point, if I’m not seeing it, we’re going to stop it.”

Though, Pohl said he understands why a doctors are quick to prescribe pain medication.

“Doctors see a patient in pain and they want to help,” Pohl said. “Maybe that’s co-dependent or enabling behavior but its’ really partly desire and compassion.”

For many patients who are still experiencing pain, the thought of stepping away from opioids can be daunting. Pohl said his goal is to reduce his clients’ pain by 50 percent through a menu of options, including a topical analgesic cream that might reduce pain by 5 percent.

“Which doesn’t sound like much,” Pohl said, “but if you get 5 or 10 percent pain reduction from a cream and you get 5 or 10 percent reduction from meditation and your 5 or 10 percent reduction from stretching, and take a couple of Tylenol, you’ve got 40 percent pain reduction.”

And for patients who do wean themselves off of drugs like Vicodin, there’s still the issue of them selling those drugs on the street. Retreat of Lancaster County Medical Director Joe Troncale said drug testing could be a way to halt that.

“It’s kind of the reverse of what we usually think about as drug testing,” Troncale said. “But if you drug test someone who is supposed to be taking, for instance, an opiate and there are no opiates in their system, that raises a big red flag that they may be diverting the opiates.”

Troncale suggests testing all patients seeking an extension on a painkiller prescription, not just those who are suspected of selling the drugs. He said the universal rule will help remove stigmas associated with the test and it could also help narrow in on patients abusing other drugs. However, most insurance policies don’t cover such testing.

“The practices usually eat that cost as just, sort of, the price of doing business,” Troncale said. 

Several state agencies and departments have established the Safe and Effective Prescribing Practices and Pain Management Task Force, which aims at educating doctors and patients about the dangers of opioid use and abuse, with the goal or reducing the growing number of drug related deaths in Pennsylvania. 

In the meantime, a bill in the Pennsylvania Senate Public Health and Welfare Committee would limit the length of a prescription for an opioid that could be written upon release from an emergency room from the current 30 days to just seven days. The bill has not yet been called for debate.

Health care coverage on 90.5 WESA is made possible in part by a grant from the Jewish Healthcare Foundation.