One of the hottest topics today is the national opioid epidemic.
This national crisis is a culmination of may factors, ultimately resulting in poor coping mechanisms on the part of patient, and ineffective and fearful prescribing patterns on the part of physicians.
A couple of years ago, there was a particularly poignant television interview between Dr. Mehmet Oz and Steven Tyler of Arrowsmith fame. Mr. Tyler is no stranger to the world of sex, drugs, and rock and roll. He points out correctly that the number one drug pushers in the country are physicians. For example, almost anyone going into an emergency room or urgent care center with any degree of back spasms is going to walk out with a prescription for Norco, Vicodin, Tylenol 3 or 4, Lortab,OxyContin, or other Opioid equivalent products. This is not for treating back pain resulting from a kidney stone, or a rare central ruptured disc that clearly requires Morphine or Dilaudid. Rather the patient demands something “strong” for their back pain and physicians are concerned about patient satisfaction surveys and the social media implications that evolve from their medical decisions. As a result, rather than prescribing a course of non steroidal anti inflammatory agents such as Motrin or Aleve, or even a short course of Prednisone in conjunction with a muscle relaxant, physicians tend to take least confrontational and easy course of action. This is despite medical evidence to the contrary of the lack of effectiveness of opioids in musculoskeletal pain.
In the office setting, it does take more time to explain to patients that the right course of treatment is conservative in the use of musculoskeletal pain medications. I may even suffer some remonstrance on the part of the patient. Physicians need to convey that this is the medically correct and ethical thing to do. Patients also need to know that time is a great healer and with ice, moist heat, non steroidal anti-inflammatories, muscle relaxants, and physical therapy, their pain will be alleviated in a reasonable time period.
The opioids have the side effects of mental obtundation, dizziness, and constipation which create a whole new set of problems. Of course, in every practice there are exceptions to the rule where certain patients will require moderate doses of opioids for a reasonable quality of life. These situations must be evaluated on a case by case basis and require a strong relationship and an element of trust between the doctor and the patient.
About the Author:
A highly successful Doctor with a practice in West Bloomfield, Michigan, Jim is also an award-winning broadcast journalist who has served as the “on-air” medical expert for various Detroit radio stations, including: WWJ Radio in Detroit (CBS owned and operated), WJBK-TV (Detroit’s FOX network affiliate) and WKBD in Detroit. He has over 20 years of experience in the medical media industry, including nine years as a national radio medical expert for CNN.
Dr. Jim Bragman has 30 years of experience in private practice, and is also a clinical teacher of medicine at the Wayne State and Michigan State University College of Osteopathic Medical Schools.