Page 15 - Delaware Medical Journal - May 2016

OPINION
Force to Reduce Opioid Abuse want to ensure that America’s physicians, patients, and policymakers take action in three ways:
First, we must change the conversation about what it means to have a substance use disorder and we also must increase access
to evidence-based treatments. This means putting an end to stigma, increasing access to medication-assisted treatment (MAT) for opioid use disorder, and supporting the expanded use of naloxone – a life-saving medication that can reverse the effects of an opioid-related overdose. People with a substance use disorder deserve to be treated like any other patient with a medical disease, and physicians are helping the nation understand how to do this. That is one reason the Task Force encourages increased education and training for MAT.
Second, we encourage physicians, dentists, and other prescribers of controlled substances to register for and use prescription drug monitoring programs (PDMP) – as one tool to identify when a patient may need counseling and treatment for a substance use disorder. The trend among policymakers has been to use PDMPs to identify “doctor shoppers.” This, by itself, is important, but the real work is to understand why a patient is seeking medication from multiple prescribers or dispensers – and to offer a pathway for treatment and recovery. The information in PDMPs can play a helpful role in identifying patients in need of help.
Third, consider that we must do a better job with prevention. This includes intervening early with teens who initiate alcohol and/
or marijuana use as well as efforts to encourage safe storage and disposal. Unused medications increase the risk of nonmedical
use by adolescents who live in the home or by their friends. Unused medication also can be ingested by young children who are curious about what is inside the pill container. Implementing campaigns to educate the public on the importance of storing opioid medications locked and out of the reach of children, and properly disposing opioid medications following the end of use, can encourage these safe practices.
And this also includes recognizing that we must actively screen for and treat co-morbid psychiatric disorders in all our patients to ensure that they continue to receive the highest level of care since patients with psychiatric conditions may have even greater risk than the general population to misuse opioids. Furthermore, intervention, and referral to treatment (SBIRT).
There are additional issues that we must address. Pregnancy should not limit a woman’s access to opioid medications for adequate pain relief. Pregnant women should not be coerced to withdrawal from opioid treatment. And punitive measures
taken toward pregnant women, such as criminal prosecution and incarceration, should be eliminated. These activities have
use opioids from seeking prenatal care, leading to poor child health outcomes. The threat of punitive measures also limits the disclosure by pregnant women of critical information about their drug use to their physician. A pregnant woman should have the same freedom as others to openly discuss options with her physician, choose a course of treatment, and be monitored/ supported by her physician.
We also need to guard against limiting MAT services. For example, many states have enacted limits on MAT for patients in Medicaid programs, who are incarcerated, or who have “failed” a prior treatment program. Just as an evidence-based treatment policy would not discriminate against a diabetes patient for being low-income, having been arrested, or not adhering with his or her diabetes treatment program, MAT’s proven success should not be limited by these approaches either.
As physicians and dentists, we see the harsh reality faced by our patients with a substance use disorder. Stigmatizing patients
helps no one. Our goal, as physicians and dentists, is to treat our patients and help them live as fully functional members of society. There are people in recovery at every level of government, the private sector, and throughout our towns and communities. That is because treatment works.
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