Wed, Sep 19, 2018 at 08:00 PM
Dr. Victor Sparks puts the complex situation of opioid addiction into historical perspective, and says there are many culprits.
The seeds that produced the current opioid crisis were planted decades ago when the government began demanding doctors address pain with the same importance they place on blood pressure and heart rate. Basing treatment on a patient’s assessment of suffering led to doling out painkillers that carry a crippling rate of addiction.
“We’re all to blame in some form or fashion,” said Dr. Victor Sparks, who has watched this trend for more than two decades working in Marshall North’s emergency department.
Dr. Sparks addressed the opioid crisis during the Lake Guntersville Chamber of Commerce Annual Healthcare Breakfast. The event, now in its ninth year, is sponsored by Marshall Medical Centers. About 150 people were in attendance.
Chronic pain is a legitimate medical complaint, affecting 19 percent of the U.S. population or 39 million people. Records show that 149 million work days are lost due to lower back pain, costing the country billions each year.
“Those of us in healthcare bear the responsibility of helping people with pain,” Dr. Sparks said.
In fact, in the 1990s, pain was named “the fifth vital sign,” giving it equal status with blood pressure, heart rate, respiratory rate and temperature. The policy encouraged healthcare providers to ask patients about their pain. Soon after, the Joint Commission and others called for pain to be regularly assessed in all patients. Because pain is a subjective measure, unlike heart rate or blood pressure, physicians must accept patients self-reporting of pain.
“That’s a real problem,” Dr. Sparks said.
Adding to the problem, pain levels became associated with patient satisfaction. The Joint Commission, which accredits hospitals, required hospitals to ask patients about the quality of their pain care. Medicare’s funding formula required hospitals to prove they provide good care through patient satisfaction surveys. The formula rewarded hospitals rated highly by patients, while penalizing those that were not.
As a result, in order to meet the regulations and reduce patients’ pain, doctors used the most effective tool they had – narcotic opioids.
“They are the most efficacious way to treat pain,” he said.
Doctors were taught two pills a day would deliver 24-hour pain control, so that’s what they prescribed. Drug companies pushed long-acting narcotics as ‘less addictive.’
“We all bought into this as the way we’re going to be able to treat chronic pain,” Dr. Sparks said.
Then reality set in. The medications actually lasted only eight hours, requiring more to treat breakthrough pain, which led to addiction and withdrawals. The 20-50 year old age group has the highest rates of addition. Dr. Sparks said it is partly their own fault but also because they were raised to believe that any pain should be completely controlled.
Now that the opioid crisis has become national news and because most people know someone who is dealing with addiction, solutions are being sought. Hospital survey questions about pain management have been removed. More money is being put into treatment options. And the American Medical Association is recommending that pain be removed as a “fifth vital sign” in professional medical standards and is urging the Joint Commission to stop requiring hospitals to ask patients about the quality of their pain care, calling it an overly simplistic approach to measuring clinical effectiveness.
Doctors and providers also are trying to do better. Marshall Medical has adopted a policy that doctors will care for patients and treat emergencies, but they won’t use narcotics for long-term pain.
“We can address pain as we feel needed, but we’re allowed to make the decisions,” Dr. Sparks said.
He urged people to talk to their physician about alternatives to pain killers, such as non-habit forming drugs, physical therapy and possibly even less understood treatments such as acupuncture.
“We need to realize that every problem in the world can’t be handled by taking a pill,” he said.
For a photo of Dr. Spark's and more about his talk you can read The Advertiser-Gleam story here https://bit.ly/2NUuSTD.