President Donald Trump has declared the opioid crisis a public health emergency, and more states are crafting guidelines on how to prevent patients from becoming addicted by practicing “precision prescribing.”
Michigan enacted a program in October of 2016 called OPEN (Opioid Prescribing Engagement Network), which seeks to educate patients and providers on the risks of opioid use, while also limiting the amount of pills in circulation.
“The vast majority of people who end up abusing opioids start off opioid naive, and then they have some interaction with the healthcare system like a dentist or a surgeon,” Dr. Michael Englesbe, OPEN’s co-director, told The Daily Caller News Foundation.
Englesbe is a transplant surgeon who serves as a professor of surgery at the University of Michigan, and says the blame for the opioid crisis lies “squarely” with dentists and surgeons for creating a culture of over-prescribing.
“A lot of patients became hooked on opioids, and it’s obviously not their fault,” Englesbe said. “A lot of the blame is squarely on surgeons and dentists. We just gave people a lot of opioids.”
“People would have their wisdom teeth out and get sixty opioids,” he added. Englesbe said doctors offices were more concerned with making sure their patients were “satisfied” than with addressing the risks of addiction. OPEN is educating health care professionals on ways to reduce these risks, starting with setting standards for prescribing.
“We basically educate nurses and doctors on appropriate prescribing,” Englesbe said. OPEN has rolled out statewide recommendations, outlining how much medication should be prescribed for each surgery and procedure. They have also provided “standardized education materials” for doctors and patients, to help educate them on the safe use and disposal of additive narcotics.
“Trying to standardize opioid prescribing across the state is really our primary goal at this point. If we could do that we could reduce opioid prescribing by about 50 percent in the state of Michigan. Which will have a huge spill over effect on our communities and our patients,” he added.
Englesbe believes the majority of people having minor medical procedures don’t need to be inundated with opioids. “We are looking to change the care paradigm. I don’t know how we got to a place where we’re writing [prescriptions] for fifty pills after we do a hernia repair.”
Englesbe said it’s a matter of giving patients “just the right amount of opioids” and then encouraging them to return any unused drugs. According to Englesbe, there are “literally billions” of leftover pills across the country that are feeding the epidemic. The process for disposal is still developing, and has restrictions which make it difficult for patients to comply. Englesbe said most “take back” locations are law enforcement establishments and this intimidates patients.
“We work within communities to do the pill drives where people will go,” he said. “Like local schools and local hospitals. People bring their pills and we get rid of them.”
Englesbe said law enforcement must still be present to collect and incinerate the pills, but OPEN is working hard to change the rules to lessen the regulations, making it easier on patients. He also said one of the main problems contributing to opioid dependency is a lack of funding for mental health care.
“It’s essentially a money losing business. So additional support for mental health and addiction services is the second most important issue,” the first being prevention.
“I don’t think regulations and laws are going to fix this problem,” Englesbe added. He said patients have to start demanding something be done, and that is what will change the culture.
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