Doctors fight for patients in opioid battle

(Source: KAIT-TV)
(Source: KAIT-TV)

JONESBORO, AR (KAIT) - The employees at one Region 8 hospital are working to treat patients and battle a problem that has impacted communities around the country.

Doctors with St. Bernards Medical Center have created an Opioid Abuse Coalition to combat the opioid addiction being seen across the country and at home in Region 8.

As a part of that issue, emergency room physicians and the nation's foremost expert on the topic spent Wednesday at St. Bernards talking to physicians and hospital staff.

Emergency room physician Jason McElyea said this issue is now known nationwide.

"We all know there's an opioid epidemic," Dr. McElyea said. "We've all got family members that have been involved in this. Everybody can reach out and think, 'oh, yeah I know someone who's been on pain medicine. Come off of pain medicine.' It's really been pushed with the last two presidential administrations to have some reform in the area."

Dr. McElyea said he wanted to help doctors come up with other solutions before they pull out a narcotic.

"What I'm talking about," Dr. McElyea said. "Is how doctors can safely reduce the amount of opioids that are available to patients. A lot of people do okay with pain medicine, they take it and their fine. A lot of people do okay with drinking too. But it's the same concept. You don't know you're an alcoholic until you take that first drink. That's what I'm trying to do for pain medicines. Educate doctors on there are better first, second and third line therapies before you get to an opioid. And people are becoming much more aware that opioids are killers. This is a medication that yeah, you may do fine, but 10% of the population is going to become dependent on that. So, how can we avoid that? How can we delay that first exposure? And how can we recognize that they really are dangerous?"

Director of St. Bernards Medical Center Hospitalist and Chair of the Education Communication Committee, Dr. Jordan Janik, said they were thrilled to have Dr. McElyea visit with them.

"We're pretty excited about Dr. McElyea being here," Dr. Janik said. "An ongoing topic in the world, the country and Region 8 is opioid addiction and overdose. We want to shed some light on and educate the region to the crisis that's going on around us."

"Medications that we've been using for years," McElyea said. "Whenever I give this presentation on a grander level, I'll go through like headaches. Here's what we can start with for headaches. Because people got kind of used to coming into the ER and the hospital and getting a shot of pain medicine and some nausea medicine and going home. But we find we can use old blood pressure medicines, anti-depressants, sleep medications. They have a lot better safety profile without as much of a habit-forming pattern."

Dr. McElyea is traveling across the country to raise awareness and educate people about this issue.

"In states that I travel to," McElyea said. "I speak with legislators about even doing informed consent for opioid prescribing and realizing that we are at this point where we're deciding to prescribe and opioid. But as the physician, as part of our relationship, we have to realize that this is a risky drug. If you were to go out now and start a new drug, discover a new drug and it had a 10% chance of addiction and a 1% chance of death, that would never pass. So, this medication has become so ingrained into our system that we've turned a blind eye to it. And now, with so many better alternatives there's just not really a good reason to have so many people dependent on opioids."

Dr. McElyea has focused his research on hospitals and emergency rooms.

"I've worked with the CDC," Dr. McElyea said.  "Also, the US Department of Health and the Surgeon General. What we face is we've used opioids for so long. We're so used to prescribing them we're afraid what happens if I don't do it. So, my research is focused on the hospital environment and the ER. If we can just delay that exposure. If we can try better medicines first. What happens, we're able to show people get better. People aren't in the hospital as long. People are happier with the level of their pain control when they're not getting narcotics around the clock. And they have a better experience because the doctor and the nurse sit down and talk to them. They say we understand this opioid would immediately relieve your pain, but it won't fix anything. What we want to do is address the actual problem rather than masking it. Let's address it. We have a medicine that is more focused for what you have going on. I use the example of if somebody came in with their leg cut off. If I give them a narcotic, they're going to feel better. But they're leg didn't grow back. If they have a broken bone and I give them a narcotic, they feel better. But the bones not fixed."

Dr. McElyea said this problem has grown over time.

"It's fed on itself," McElyea said. "As patients began to expect pain medicine for everything. Pain is the fifth vital. Sometimes it's an unpopular thing to say because vital signs are vital. That means if you have a zero for that vital sign, then you die. If your heart rate is zero, if your oxygen is zero, if your blood pressure is zero, if your temperature is zero then you die. It's an unpopular thing to say. Pain doesn't kill people. We can learn to deal with it and learn to minimize it in the most effective way. But it's never going to be something that has a mortal impact on somebody. But as we've gotten into that mindset, doctors feel pressure. And it was on surveys that reimbursement was tied to. And that ended up with 74% of doctors will tell you I feel pressured to prescribe opioids because it's what my patients expect, it's what my administration expects and it's what the region expects. And it may be handed down to them. . . do this or else. And that was really my push. To show we can help people without the opioids. We've got research that says time after time that if we're getting better and more targeted therapies, the length of stay goes down. People are not in the hospital as long. The mortality goes down. Because a common reason for people to have a rapid response. . .there's a sudden change in the patient's condition in the hospital is narcotics. A patient gets pain medicine and it hits them pretty quick. They're in a safe environment, but all the sudden that pain medicine hits them all at once and we're having to respond to try and reverse that. If you remove that offending agent and try something better, you have a lot less emergency situations that are created."

Dr. Janik said they've seen this problem at home.

"We kind of see things on both ends," Dr. Janik said. "It's part of a give and take. A lot of in the forefront is the overdose and addiction part of it. But also overprescribing is a big deal. No one's to blame. It's just something we have to work together to really get a handle on and educate people. Maybe an opioid is not the first line medicine or is not the right drug of choice in certain conditions."

Dr. Janik said he and his co-workers want to stop their patients' pain, but above all, want them to be well.

"I would like patients to know," Dr. Janik said. "First and foremost, we want to help them. We want to help your pain get controlled. We're people just like you and everyone has pain for various reasons and the bottom line is we want to help. But we want to figure out how to help without just throwing the medicine at you to calm something or alleviate the pain, but not fix the problem. So, we need to work as a team to really get down to the root cause of what is going on."

"You hurt for a reason," Dr. McElyea said. "If your back or leg hurts your body is telling you that something is going on. If we mask that then we're missing the problem and not addressing it. If you had chest pain, we used to give people a narcotic. Well, they were still having lack of blood flow to their heart. But they didn't care about it. They didn't feel it. We had masked those symptoms. And we've learned doing that, we caused a lot more damage. We may have helped with the anxiety of it, but we didn't' help with the blood flow issue as well as we could have with other drugs. Now, we're going back and finding out that we probably did a lot more damage by giving those narcotics whenever we did. Because they inhibit some of the blood thinners that we use on cardiac patients."

Dr. McElyea said you can help by engaging with your doctor and remembering you both have the same goal.

"Just ask," McElyea said. "Just talk, listen. Just be a person. Realize that your provider wants what's best for you and that it's not a judgment thing. I never tell doctors not to write narcotics. I tell doctors to stop and think is there a better alternative. What's actually going on with the patient? Listen to the patient. Listen to the provider. Patients know the pain medicine will make them feel better, but there's still something else going on that we need to address and rather than mask the symptoms, let's get to the bottom of it. Let's not jump to the elephant gun when all we really need is a fly swatter."

McElyea said research has shown that by reducing the amount of narcotics utilized they are reducing narcotics in communities.

As a result, the amount of drug-related crimes in those areas have gone down.

"We're not prescribing the heavy opioids," Dr. McElyea said. "We're not prescribing opioids for a routine pain complaint. Your back hurts, let's try something a little bit better. And those people that would've become addicted or those people that were casual abusers, it's not worth it anymore. They're not going to get it. They've got other things to do and now we're starting to see this education uplift of people. Because whenever you take that out of their hands, as far as a quick easy fix, doctors have to think more. They have to work things up. They find things. I've had patients who came to me with back pain, I use that as an example, that they're provider was giving them narcotic pain medicine for months only to find out that they had metastatic prostate cancer. Because I lifted and then my back hurt, it's a muscle strain. Let's put you on some pain medicine and it goes on and on. So, it's like we're removing a crutch and we're really empowering physicians and providers to stop and think about the patient. I think we're reconnecting people."

For more information about St. Bernards Medical Center, click here.

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