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Since 2009, there have been more than 14,500 cases of heroin and opioid overdoses in emergency rooms across the state. (Photo by Johanna Huckeba/Cronkite News)
Experts: Doctor training key to fighting opioid epidemic
By Ally Carr | Cronkite News
Thursday, January 5, 2017
PHOENIX – When Dr. Patricia Lebensohn prescribed a narcotic to a man with chronic pain years ago, she thought she had done everything right. The Tucson doctor had him sign a pain management contract to make sure he would not take any other drugs or get more pain medications from other doctors.
“I prescribed the usual,” she said. “I wasn’t excessive.”
But her patient took a bunch of his pain medication and mixed it with alcohol, she said. He overdosed and died.
That incident left an impression on Lebensohn, who wants to change the way doctors treat chronic pain in Arizona. Doctors often rely on dangerous and highly addictive narcotics to treat patients with pain, which has helped feed a nationwide epidemic that has exploded because of cultural shifts, consumer demands and poor doctor training.
She’s in charge of adding new guidelines on how to properly prescribe opioids and address chronic pain in the curriculum at the University of Arizona’s medical school in Tucson.
Many experts say doctor training is key to dealing with the national opioid epidemic.
About 72 percent of the doctors surveyed in one recent study indicated their knowledge of opioid dependence was low, and many rated their training as “unsatisfactory,” according to a 2016 study published in the Drug and Alcohol Dependence journal.
Although Arizona has developed a training program for doctors on prescribing opioids and treating chronic pain, the state does not mandate doctors take continuing education in pain management, controlled-substance prescribing or substance-abuse disorders – as several other states do. University of Arizona College of Medicine – Tucson, the state’s largest medical school that offers a doctor of medicine degree, has offered some classes in this area and it plans to add more.
In 2014, more than 14,000 people died in the U.S. from prescription opioid-related overdoses, according to the Centers for Disease Control and Prevention.
“It’s kind of sexy to talk about things like pill mills and illegal drugs coming from China, but in fact, the majority of people who get hooked on pills started out with a prescription that was totally legitimate,” said Corey Davis, an attorney for the Network for Public Health Law and author of a study evaluating continuing education for physicians.
He said something needs to change.
“If they had been teaching doctors something else that was resulting in the deaths of thousands and thousands of patients a year, they would do something to stop that immediately,” Davis said. “And the fact that they’re not doing that here, I think suggests that they don’t take it incredibly seriously.”
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Dr. Craig Norquist, an emergency medicine physician at Scottsdale Emergency Associates, said that when doctors recognize the name of a patient who keeps returning to the emergency room to get more pain medication ”that's a failure of the system.” (Photo by Ally Carr/Cronkite News)
Pervasive problem
Pain relievers accounted for nearly 60 percent of all pills prescribed in Arizona in 2013, according to a presentation for the Bureau of Justice Assistance at the 2014 prescription drug monitoring program national meeting.
“Pain management in our country has become almost unanimous with use of narcotics,” said Mazda Shirazi, medical director of the Arizona Poison and Drug Information Center at the University of Arizona College of Pharmacy.
For a long time, many doctors believed these narcotics were safe.
A 1980 letter to the editor in the New England Journal of Medicine indicated patients would not get addicted to narcotics, so physicians started to prescribe pain medications more liberally, said Craig Norquist, an emergency physician and former president of the Arizona chapter of the American College of Emergency Physicians.
In the 1990s, many doctors thought “there’s no good reason to withhold pain medication” because they were “still under the misbelief from that article that addiction would not happen to people who had legitimate pain,” he said."
https://cronkitenews.azpbs.org/hookedrx/doctor-training-pain-management-opioids/
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