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Monday Oct 19, 2015

Prescription for Pain? Important Questions Patients Should Ask

Earlier this year, I shared with you a story about being willing to take carefully considered risks, boldly sticking your neck out to make your message heard. Specifically, I made an appearance on The Dr. Oz Show in May because it was an opportunity to reach roughly 2 million TV viewers (and even more online) with a message about the importance of primary care and why everyone needs a family physician.

Fast forward a few months, and I was asked to make another appearance on the show, this time for a segment about proper use of pain medications. According to the CDC, nearly 2 million Americans abuse prescription painkillers(www.cdc.gov) and roughly 7,000 patients are treated every day in emergency departments for that misuse. Opioid prescribing, pain management and opioid abuse are issues the AAFP has been working on diligently for years -- including efforts related to advocacy, public health and education -- so I was eager to participate.

Here I am with Ada Cooper, D.D.S., spokesperson for the American Dental Association, and Mehmet Oz, M.D. We discussed appropriate use of opioids during a recent taping of The Dr. Oz Show.

The episode aired Oct. 19, but more on that in a minute.

It's been a rough year-and-a-half for host Mehmet Oz, M.D. He was called before Congress last year because of his promotion of weight loss medications, and a group of his peers called for his dismissal from his post at Columbia University.

His critics certainly got his attention. Oz conducted a listening tour(bigstory.ap.org) with various medical groups this year and has vowed to make his show more evidence-based. He has sought input from many physicians and physician groups along the way, including the AAFP. I recently met with Oz, his staff, AAFP staff and members of the New York State AFP to talk about how family medicine can help make his show more evidence-based while also reflecting the importance of prevention and primary care.

The first step in this potential collaboration was the episode addressing the epidemic of opioid abuse. Use of opioid pain relievers in the United States quadrupled between 1999 and 2010. Among the 22,810 deaths related to pharmaceutical overdoses in 2011, nearly three-fourths involved opioids. In 2012, U.S. health care professionals wrote enough prescriptions -- 259 million -- for every American adult to have a bottle of pills.

So with access to an audience of millions of American patients, Oz and I discussed important questions patients should ask their doctors before starting a prescription pain medication. Here's a look at some of the questions and the information I provided.

What is the goal of taking this prescription?
This is an important question because patients need to make informed decisions. Too often, people take medication without understanding its risks and benefits and without asking if other options are available. Patients need to understand why they are taking a pain reliever, what kind of pain reliever they are taking and how much relief they should expect.

How long should I take these drugs?
Opioids are best used for the shortest time possible and at the lowest dose possible. I told the audience that they should know from the start how long they are supposed to take a medication. And if they think they have been on a medication too long, they should talk to their physician.

Are there any risks to me from these pills?
When I perform a risk assessment, I look for the following factors:

  • any history of addiction to or misuse of opioids;
  • any history of addiction to or misuse of alcohol or drugs other than opioids;
  • depression or other behavioral health disorders; and
  • is the patient taking any medications that might provoke an adverse reaction in combination with the opioid?

What do I do with extra pills?
We discussed the importance of safe disposal, including take-back programs, and the need to store pills in a secure location.

The questions can be downloaded(s.doctoroz.com) as a resource for patients receiving a prescription for pain killers.

The AAFP will continue to work on this important issue. On Oct. 21, I will be in Charleston, W.Va., when President Obama speaks with law enforcement, educators, lawmakers and health professionals during a forum on opioid addiction. Watch for more details about that event in AAFP News.

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Posted at 01:24PM Oct 19, 2015 by Wanda Filer, M.D.

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