We can combat opioid epidemic by changing healthcare policy

As we were racing to the recovery room, we heard screams, that increasing got louder and louder, until it almost became almost too loud for our team to bear. We thought something was terribly wrong. Could it be a massive heart attack or a postoperative stroke, or a devastating complication after surgery?

This is a typical daily occurrence across the United States, but today this was our patient. This time it was our patient, a 62-year-old woman who had just arrived in the recovery room. She had just awakened safely after a total hip replacement.

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We were moved within minutes from the operating room table to the recovery room floors and placed the monitor on her to assess how quickly her heart was racing to rule out if anything else was going wrong.

 

But what we found was nothing more than the usual benign problem — uncontrolled pain. And one by one team members walk away, removing gloves, shaking hands, thanking each other that is was nothing worse.

But what about the patient? She was still in pain. Her pain was still uncontrolled. And what she will go home remembering most about the entire experience? Not that our entire time did everything to keep her alive, but the uncontrolled pain she had after she safely awoke.

She looked at both of us with glassy watery eyes and demanded we do more for her pain. Her increased tolerance to pain medication isn’t something unusual — we have encountered it repeatedly given the opioid epidemic and it has only been an increasing challenge. Now we have a new problem a — new rise of heroin use.

Our patient was managed eventually safely and responsibly with opioids, which most everyone requires after surgery. She went home with a small supply of opioids with a Centers for Disease Control and Prevention (CDC) supported opioid wean regimen and instructions to follow up with her surgeon.

But much to our avail, she returned to the hospital in a heroin withdrawal crisis because our supply was not enough, and now her pain was again out of control and her heroin withdrawing. We were asked to come evaluate her rapidly to determine next steps of care. 

This is the usual occurrence in hospitals across major cities in the United States. Policy, guidelines, innovations aside — patients are still suffering. We are not making great progress — in fact, more are addicted than ever and new reports indicate a rapid increase of heroin use given the shift of less opioid use. What are doctors and patients to do?

We have witnessed first-hand how seemingly polite people can get frustrated if healthcare professionals deem their requests as unsafe or excessive. The side effects of severe constipation, somnolence and respiratory depression aren’t even a consideration.

This creates a tense environment for those in the healthcare field, who are torn between exercising sound medical judgement and the compassion to alleviate patient concerns.

We have witnessed first-hand countless patients come into the hospital with a non-pain-related critical illness, only to sign out against medical advice because they were dissatisfied with their pain management.

Despite all that would go wrong, these patients remain focused on getting their pain controlled no matter what the health cost is to them. This attitude turns into a cycle of admissions and discharges from the hospital, ultimately taking up more healthcare resources, adding to the already overburdened healthcare system.

To add to this, the healthcare system is rapid unraveling. The Affordable Care Act (ACA), implemented in 2010, attempted to address this epidemic but is falling short. And now with a fragile health system in delicate balance, patients are falling through the cracks.

The ACA has helped millions seek help for their addiction disorders, and obtain both psychological therapy and medication for their conditions. But with it came much less time to spend with patients, because it increased burdensome compliance and quality metrics. Time that is spent talking, communicating and discussing with patients is healing and is what having a doctor-patient relationship is all about. Without that, patients in pain suffer more, hurt more and are more likely to have a prescription handed to them due to the rushed conversation.

Policy may have the power to change this by protecting this coveted time. This time allows for discussion of innovations, new treatments, options, risks, alternatives, and maybe includes discussions with family and caretakers who are critical to help pain patients get better.

Seeing patients suffer for something that is preventable is very disheartening, in addition to the added strain it places on the healthcare system. It is our duty as physicians to do our part in caring for the whole patient; the decreasing time we have to talk to our patients and the ripples it has is a core issue that often gets lost.

 

Dr. Anita Gupta is currently a 2017-2018 fellow at Princeton University at the Woodrow Wilson School of Public and International Affairs and vice chair and associate professor at Drexel University College of Medicine in Philadelphia. She is currently an adviser at the FDA and a pain committee member of the American Society of Anesthesiology on the opioid epidemic.

Dr. Jashen Patheja is currently a anesthesiology resident at Drexel University College of Medicine in Philadelphia and is an active member of the American Society of Anesthesiology and actively participates in being a voice for patients on issues related to pain, patient safety, and opioid related complications.


The views of contributors are their own and are not the views of The Hill.