Finding the Balance Between Pain and Addiction According to Dr. J. Fred Stoner
As the opioid epidemic rages on, killing tens of thousands of Americans annually, doctors and lawmakers are trying to find where the balance lies between meeting the pain reduction needs of patients and preventing their addiction and death. Dr. Joseph Fred Stoner is a leading pathologist and clinical pain management specialist based in New Castle, Pennsylvania. He took the time to outline the balance between pain and addiction, and to share his insights into the opioid epidemic.
More than 30,000 Americans were killed by an overdose of synthetic opioids in the 12-month period ending September 2018 according to CDC data, a staggering 500% increase in the span of just five years.
Dr. J. Fred Stoner shares that the rapidly developing opioid crisis has been so deadly that U.S. life expectancy rates have fallen in each of the last three years, an unprecedented occurrence in a developed nation since the end of World War II.
Synthetic opioids like fentanyl are even deadlier than heroin due to their sheer potency, being fatal in doses of as little as 0.25mg, which can make even small miscalculations in dosage deadly. The drugs are routinely diverted into the hands of addicts and dealers, being cheaper and more powerful than heroin.
Expectations of No Pain Are Unrealistic
Doctors, who have taken the brunt of the blame for the crisis due to overprescribing the powerful opioids, are increasingly realizing that the expectations of patients need to be better managed for their own safety.
Whereas it was often felt, and even taught, that patients shouldn’t have to feel any pain, it’s now becoming accepted that a little pain is far preferable to an early grave. Doctors are instead turning to various less powerful and less deadly alternatives to treat pain.
J. Fred Stoner states that many of the traditional treatments that fell in popularity due to the ease of prescribing powerful pain-relieving opioids are now making comebacks. Further stating that among them are the application of heat and cold to affected areas, rehabilitating injuries through physical therapy, and prescribing less potent medications to dull pain.
Doctors are also taking further steps to ensure the opioid prescriptions they do write are more likely to be used for their intended purpose. In the case of surgery, some doctors are waiting until the day of an operation to write a prescription rather than days in advance.
Prescription sizes are also being lowered considerably, with doctors now erring on the side of caution (and more frequent refills if necessary) rather than excess and unused pills that have a chance of being diverted or overindulged on.
Lawmakers Joining the Opioid Fight
Doctors are also doing more to educate patients about the risks and addiction treatment options available to them, more of which have become available in recent years thanks to aggressive funding from local, state and federal governments.
Dr. J. Fred Stoner explains that both President Obama and President Trump have passed bills in recent years that have expanded opioid treatment options and educational programs and tackled opioid trafficking.
Health officials have also pushed for wider availability of naloxone among both police forces and the general populace, with several states now allowing the opioid overdose-reversing drug to be picked up at pharmacies without prescriptions.
According to Dr. J. Fred Stoner, some states are also doing more to help doctors make informed prescription decisions, such as the launch of a prescription database in Pennsylvania in 2014 which allows doctors to reference whether patients are receiving opioid prescriptions from multiple sources. The number of opioid prescriptions issued in the state declined by 12% during the fourth-quarter of 2017 compared to a year prior.
Dr. J. Fred Stoner’s Final Thoughts
Though a lot more needs to be done, the concerted effort by doctors and lawmakers is bearing fruit. Between August and September 2018 (the most recent data available from the CDC), there was a month-over-month reduction in the number of synthetic opioid deaths over the previous 12-month period for the time since the crisis started. Dr. J. Fred Stoner is excited about the progress that has been made; however, he states more change must arrive soon or else the positive efforts already been made may reverse.
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