We’ve all heard these phrases like the ones below since childhood, from people in positions of authority:
You reap what you sow.
You’ve made your bed, now you’ll have to lie in it.
Clean up your own mess.
Last month, when I was attending Dr. Lloyd Sederer’s webinar on the Opioid Epidemic, (Managing the Opioid Epidemic; Four Secrets in Plain Sight), it struck me that those pearls of wisdom from childhood apply to us all in the healthcare field.
Dr. Sederer talked about how the way we treat pain and other conditions is impacting the opioid epidemic. The biggest growth in use of opioids in the U.S. is seen with white men, HS educated or less, who are chronic pain sufferers. They aren’t illegal heroin users, but rather chronic pain sufferers with valid prescriptions. Take a moment to ponder this and let it sink in.
A big part of the opioid epidemic is our own medical and pharmacological community. This epidemic isn’t about illicit streets drugs being manufactured in run-down buildings and back alleys (cue the dramatic music and scene from any number of crime movies and TV shows). We in the healthcare field, the ones responsible for helping and healing, have actually had a hand in creating this epidemic because of how we view and treat pain.
Not to give away everything in the webinar but secret #3 is less is more. The overall message behind secret #3 is that we need to treat ailments in a gentle, less is more approach, versus finding more complex, side effect ridden treatments that can cause harm.
The example Dr. Sederer used was treating battlefield wounds. In 1700 B.C., it was documented that the best approach in wound care was to clean the wound with water and cover it, allowing natural healing to occur. Fast forward 3,000 years or so, when someone decided that pouring boiling oil on battlefield wounds, at this point mostly gunshot wounds, would heal them faster and better. Only when a physician ran out of oil and resorted to cleaning with water and covering for natural healing was this practice abandoned (after 200 years!) and a gentle, less is more approach adopted with better success.
The 5th Vital Sign
Fast forward once again to late 1990s when, here in the U.S., our view of pain shifted significantly. Pain became the 5th vital sign. It was something to be treated, an accredited requirement, no longer our body’s way of communicating to us how we are doing. The pharmaceutical companies took over and now, instead of healthcare workers “treating” pain through gentle, less is more techniques like physical therapy, yoga, meditation/mindfulness techniques, they turned to medications.
I’m not saying everyone in the healthcare industry quickly adopted addictive and dangerous opioid medications as the primary solution in the treatment of pain; there were many providers and professionals who knew better. There were plenty of pain clinics that focused on non-medication methods to treat and reduce chronic pain. I worked in a hospital in the behavioral health pavilion in the mid-90s and the director of the addiction programs (detox, residential, outpatient, aftercare, you name it, we had it) was also the director of the pain clinic. It was innovative. It had a Zen garden. It incorporated Eastern and Western medicine. It was focused not on immediate relief of pain through medications but on long term strategies that patients could employ at home and long after treatment ended to help manage and live with chronic pain conditions like fibromyalgia and others. I’m sure there were many such programs and forward-thinking professionals all over the country who tried to treat pain in this way.
Pharmaceuticals: A Double-edged Sword
But when big pharmaceutical companies came into the mix, things changed. You can see from this slide from Dr. Sederer’s presentation how the growth of prescription opioid medications matches the growth of opioid deaths and addiction treatment.
Instead of using opioid medications as a short term solution to manage pain resulting from another physical condition and aid in healing, we started using it as the primary solution for pain. An example of “healthy” and appropriate use of opioids would be during that first week post-surgery to treat severe pain to help a patient get up and moving, which is a key to recovery. Once the pain is manageable, not gone, other interventions that aren’t addictive can often be used effectively.
Of course it’s not all the pharmaceutical companies fault, however prescription opioids are a major contributing factor. Even more troubling, the crisis shows no sign of letting up. Pharmaceuticals are a valuable and important tool for the treatment of severe medical and psychiatric conditions. I’m not saying that they don’t have a place in treatment. However, we need to take a good look at how over-prescribing these drugs and failing to use other types of treatment have contributed to this epidemic. In the end, healthcare workers need to admit their role in creating this mess and look for ways to clean it up. There won’t be one fast and easy magical solution. Stopping the opioid epidemic is like treating severe pain, chronic conditions and behavioral health disorders. You must consider all the complex set of factors contributing to the condition, and work in a team to determine the best course of treatment.
If you didn’t get a chance to attend the webinar, it’s worth a listen of the recording. One of my favorite parts of webinars is the Q&A at the end. I’d like to give a special shout out to Open Minds for providing ample time for a lengthy discussion after. It felt as if we were all in a room together having a fruitful discussion with Dr. Sederer. The last 30 mins of the 75-minute presentation was very conversational, with smart questions asked and thoughtful commentary on contributing factors to addiction, societal factors, prevention, and treatment. We discussed how we in the healthcare and payer community contribute to the epidemic and how we are key to preventing and treating further abuse, addiction, and death. Like I said, check it out, and don’t skip the ending!
For more information on battling the opioid epidemic and what we can do in the healthcare field, click here.