Doctors’ habits affect opioid abuse


Life expectancy for Americans has declined for the second straight year — something that hasn’t been seen in more than half a century. Some have partially attributed this decline to the number of people dying from opioid overdoses. In fact, there is preliminary data suggesting that drug overdoses claim more lives than any other disease among Americans less than 50 years old. This decline has occurred despite a nationwide reduction in the number of opioid prescriptions being written by physicians.

For many people who abuse opioids (and other drugs), their first exposure often comes from people like me — physicians. As a pediatrician who works in an emergency department, I often prescribe opioids for children who have significant bone fractures. The colleagues and mentors I’ve worked with over the years do not intend to provide medications that become the gateway to drug abuse later in life. And it should be pointed out that the majority of people who use legal and illegal substances will not become addicted. However, physicians can do an even better job of making evidence-based decisions when it comes to opioid prescribing practices.

Our patients and the communities from which they come have entrusted us to regulate ourselves. With this degree of autonomy comes the responsibility to ensure we are consistently improving in order to provide the best care for our patients. To that end, there are a number of things that we can do to address the scourge of opioid abuse.

Our medical societies and governing bodies can support compulsory continuing education regarding opioid prescribing to ensure that all providers are aware of the latest evidence-based approaches to managing patients’ pain. Such efforts have been successfully implemented in other states. For example, physicians wishing to obtain a license to practice medicine in Massachusetts are mandated to take three hours of opioid prescribing training. Even though I work exclusively with children, I took the training and found it to be informative, and it has influenced how I treat my patients.

Many budding physicians write their first opioid prescription during their residency — the training we are required to have after finishing medical school. A recent study has shown that such residents are more likely than other providers to prescribe opioids for longer than five days. The governing body overseeing medical education could outline specialty-specific opioid prescribing recommendations to be taught to all residents. This would help ensure our newly minted physicians have a standardized, evidence-based foundation in pain management on which they can build.

If a patient overdoses on opioids and has the good fortune of being found and taken to an emergency department, we should ensure that they have a scheduled follow-up appointment to be seen by an addiction specialty professional before they leave the hospital.

Physicians can also empower the autonomy of the patients and families we treat. Not all patient pain necessarily requires opioids. In the cases where opioids may help and are appropriate, physicians can allow the patient (or their family member) to decide whether they want an opioid- or non-opioid-based form of pain relief.

We can also work in our communities (in schools, places of worship, and so on) to train people in how to recognize the signs of drug overdose, the appropriate use of an opioid overdose antidote and how to protect oneself when working with people who are suspected to have overdosed on opioids.

I recognize that generic, one-size-fits-all solutions can have unintended adverse consequences. We do need to ensure that certain patients (for example, people with cancer and those who are terminally ill) have access to opioids in quantities and durations supported by sound conclusions from evidence-based scientific studies, while working to minimize abuse.

For me, this sense of urgency is both professional and personal. As a pediatrician I routinely advocate for my patients who cannot always advocate for themselves. As a soon to be father, I am unnerved that my child is predicted to have less longevity than if he/she were born earlier. Because people’s lives hang in the balance, we as a society cannot afford to wait until the next report on life expectancy is released in order to meaningfully address this opioid epidemic.

By David E. Myles

Contributing Columnist

Dr. David E. Myles is a board-certified pediatrician and fellow of the American Academy of Pediatrics (AAP); his email is [email protected]. He wrote this for the Baltimore Sun.

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