Doctors and patients: The opioid prescription drug dilemma

Doctors and patients: The opioid prescription drug dilemma

BILOXI, MS (WLOX) - Opiates have been used for centuries. They are routinely and effectively used for the treatment of acute severe pain following trauma or surgery; as well as for patients with painful terminal diseases.

Short term usage is typically not considered a problem. But with more people suffering from chronic pain; the opioid epidemic is becoming challenging for both doctors and patients.

Opioid prescription use is a bigger problem in the US than anywhere else in the world. Dr. Joe Chen is a pain specialist who has worked in pain management on the Coast for more than 20 years.

"In the US we make up 80 percent of prescribed opioid medications, and I think that's a crazy amount," said Chen.

Chen says he has seen the use of opioids increase partly due to trends that started in the 90's.

"I remember going to multiple meetings and being told to treat pain aggressively. It was common standard practice to use opioids and physicians got more comfortable prescribing it," said Chen. "More of it got prescribed and the consequences we weren't really aware of until today."

A growing population of chronic pain patients - an estimated 100 million - makes treatment even more difficult. But he says he's working to help minimize potential negative consequences.

"When patients come in and say, 'I need you to fix me,' I tell them I can't fix you but we're going to try to help you," said Chen. "You have to learn life skills to keep the pain away, as well."

Because of that strategy, many of Chen's chronic pain patients have been on the same dosage for 20 years.

"You don't need to keep escalating the dosages, and you want patients to take the medications appropriately. When they take the medications appropriately there tends to be less problems with abusing the medications," Chen said.

A big part of the addiction problem with opioids, in general, is that they cause the release of certain pleasure centers in the brain; dopamines. Patients become addicted and want to continually increase the levels.

"There are other ways to increase your dopamine levels. Exercise, social activity, learning something new, going out into the world.  When you challenge your mind dopamine levels actually increase."

Even doctors who are not in pain management have to deal with the struggles of preventing opioid addiction among their patients

"Now, we as physicians are becoming more aware of the problem nationally, and we are trying to scale back how much opioids and narcotics we write prescriptions for," said general surgeon Dr. Paul Mace.

Studies show the likelihood of chronic opioid use increases with each additional day the medication is supplied.

"Sometimes if patients come in having discomfort for longer than they should, I'll do an evaluation. If I can't identify any physical problems, I'll often counsel them and say I don't think you need additional pain medication rather than putting them on the path to addiction."

Still, stricter guidelines and a growing reluctance to write prescriptions among some doctors is making it harder for patients who really need the drugs for chronic health issues.

Gulfport pharmacist Larry Krohn says blanket guidelines often hurt the patients who need the drugs the most.

"What bothers me is the government takes a broad shotgun approach and says we're going to limit narcotics. If you have cancer patients who need pain management, you need to throw those regulations out the window and take care of the cancer patients."

Dr. Chen says there are no easy answers. He has found the number one way to get the majority of chronic pain patients more pain-free and taking fewer drugs is for them to change their lifestyle with exercise and diet.

"I use this analogy for my patients: If you have a car and you know it's the last car you will ever have how are you going to take care of it? Well, I tell them that's the last body they're going to have and they need to take care of what they have," said Chen.

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