HealthTeamWorks recently caught up with Dr. Joseph Gregory, Regional Medical Director at Banner Health, for a candid conversation about the CDC’s newly released guidelines recommending reductions in opioid prescribing. Following is his perspective on opioid use in primary care.
HealthTeamWorks: What trends have you noted in primary care regarding the current level of opioid use to treat chronic pain?
Dr. Gregory: I have certainly noticed more frequent use of opioid pain medications for chronic pain management. This is an ongoing challenge in medicine, where physicians have often been criticized in the past for not being sensitive enough to pain treatment. With the greater emphasis in healthcare to measure and publicly report patient satisfaction, some physicians do feel pressure to meet patient expectations, which sometimes means more aggressive prescription of analgesics. In recent times, there has also been a big push to use longer-acting opioids for chronic pain, with those efforts being led by the pharmaceutical companies who manufacture those medications.
In the realm of specialty care, I’ve seen an uptick in the number of patients who are prescribed opioids, often following surgery. This can unfortunately lead to dependence, with patients then being referred to pain clinics where the cycle of overuse continues. We often see these patients when they are having complications/side effects related to these medications, including abdominal pain, constipation, and fatigue. Sometimes these side effects lead to ED visits and hospital stays with imaging and labs to rule out other causes of symptoms. Ultimately, when no other cause can be found, we’re forced to have difficult conversations with these patient about their dependence and formulate a plan to wean them off these medications.
HealthTeamWorks: Do you have concerns about the current situation?
Dr. Gregory: Absolutely! There are numerous consequences to opioid dependency, which include lost productivity, increased family stress, high costs of medication, increased healthcare costs, loss of quality of life and – even more important- the increased risk of death from overdose. This is really unfortunate when you consider the fact that many patients taking chronic opioids don’t even report improved quality of life or overall reduction in pain when compared to their baseline state prior to starting these medications.
HealthTeamWorks: Are you supportive of the new CDC guidelines?
Dr. Gregory: I am very supportive of these new guidelines. It’s extremely helpful to have a group of experts provide recommendations to which the rest of us can refer. We can educate our patients about these recommendations during our conversations and it helps set the standard for care in the medical community. I would also like to see more resources devoted to helping patients transition off these medications and would like to see the pharmaceutical companies be asked to contribute to this cause. We need resources for substance abuse treatment, opioid addiction management and educating patients about the dangers of opioid dependence.