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Wednesday May 06, 2015

Dealing With Addiction at Home

Roughly 320 million people live in the United States. Ponder that number for a moment while considering that in 2012, U.S. health care professionals wrote 259 million prescriptions for opioid pain killers. My state, Nevada, ranked on the high end, with more than 82 pain killer prescriptions per 100 people(www.cdc.gov).

So, although it is frustrating for physicians trying to help patients with legitimate pain issues, it's no surprise that state lawmakers have put additional restrictions on prescribers. Legislation our governor signed(www.leg.state.nv.us) into law this week authorizes the state's medical licensing board -- and the licensing boards for all other health care professionals able to prescribe opioids -- to establish new CME requirements for doing so and requires prescribers to register with a prescription drug monitoring program.

(According to the AAFP's position paper on pain management and opioid abuse, the Academy opposes mandatory CME as a prerequisite to licensure "due to the limitations on patient access to legitimate pain management needs that may occur.")

The new law comes on the heels of research that shows that roughly one-fourth of prescription painkillers are misused(journals.lww.com), and about 10 percent of patients who take them become addicted.

Dealing with chronic pain is common for family physicians in my state, where there are too few pain specialists and patients face long waits for appointments. Although we've all dealt with chronic pain in our practices, I've wondered a lot in the past year how many of my colleagues would know what to do when addiction becomes not only a professional issue but also a personal one.

This is my family's story.

My husband -- now ex-husband -- began taking prescription painkillers while recovering from an injury. If there were red flags -- and there probably were -- I missed them while working full-time and raising four kids. So it was a shock when I learned that my husband had been discharged from a family medicine practice because he was misusing his medication.

I tried to help him, and I (and others) urged him to get help. But things actually got worse. After we separated, I was again surprised when several of my physician colleagues informed me that he had approached them with requests for prescriptions. He had been doctor-shopping our friends.

Although my husband's physician was limited in what he could say to me because of the Health Insurance Portability and Accountability Act, these other physicians had no such restrictions. Why hadn't anyone talked to me sooner?

They likely weren't sure what to do or say, and it certainly would have been an incredibly awkward conversation. But maybe an early intervention might have made a difference. When there are obvious signs that a person -- and a family -- need help, it's important to speak up. Even if the conversation is difficult, you can walk away with a clear conscience knowing you had good intent.

In retrospect, I realize that I also could have benefitted from asking for help as my family went through this difficult transition. At the time, I was embarrassed that this terrible problem that I have helped my patients with had found its way into my own home. I was concerned there would be a stigma in our health care community.

I should have known better. My colleagues have been incredibly supportive. They understand addiction.

Now, I feel like I understand it better, as well. Our life experiences can affect how we treat patients, and I think I'm more empathetic now when dealing with patients who have addictions. I better understand what it's like to be that person who has to make a difficult life choice for his or her well-being and that of his or her family.

Sadly, we likely will be hearing more stories about families like mine.

It's worth noting that American Family Physician has compiled a collection of journal articles and other Academy resources related to the treatment of chronic pain. The Web page even includes links to the Academy's CME activities on management of chronic pain.

Helen Gray, M.D., is an employed family physician in Reno, Nev., working in a hospital-based setting. She also is adjunct faculty with the University of Nevada School of Medicine. You can follow her on Twitter @helengraymd.

Posted at 04:51PM May 06, 2015 by Helen Gray, M.D.

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