Like many family physicians, I have witnessed the opioid problem firsthand, seeing some who have inadvertently died, like Prince, from overdose. Deaths from opioids are increasing, and nearly 10 percent of patients who start opioids for something like a knee surgery remain on them six months later, often with worsened symptoms, psychological stress, less effective coping strategies and disability.
We family physicians have rightly been called to follow guidelines to curtail abuse, given that we see one-quarter of all office visits and prescribe one-quarter of all opioids. We must lead the effort to find a comprehensive solution — but everyone has a responsibility.
Pain is a sizable part of medical practice. Pain is complex. Our understanding is limited, its causes are many, and its treatment is challenging. In the 1980s, advocates felt doctors were not taking the relief of pain seriously. Congress responded with the "Decade of Pain Control and Research," implying that physicians had failed to make pain relief a priority and were "misinformed" about the benefits opioids could provide.
National agencies were swift to incorporate pain management protocols for hospitals, which still exist. "Pain as a Fifth Vital Sign" was touted and hospitals were scrutinized on how well pain was managed, adhering to happy face algorithms to ensure adequate pain relief.
Patient satisfaction scores were collected, creating more happy faces.
Physicians faced scrutiny from their state medical boards, who threatened disciplinary action if patients experienced unnecessary suffering and, in Minnesota, if they were sent to pain specialists. Malpractice cases were brought against undertreating physicians — with charges of patient abuse, some with public shaming and even mandatory psychiatric counseling.
In an effort to find a cure, the Minnesota Legislature recently passed a bill requiring prescribers to maintain access to the state's prescription monitoring program. I utilize this service, but it is cumbersome and doesn't integrate with my electronic health records. Removing barriers to accessing information makes sense; mandatory access on every patient every time doesn't. No studies currently demonstrate a lowering of opioid prescribing with mandatory utilization.
Recently, the Minnesota attorney general suggested that physician training on opioids be mandatory, but most receive education in their workplace. There are limited studies showing that training leads to a decrease in opioid prescriptions, likely because of our limited understanding of the epidemic.
