Brent Hunsaker, OMS 4 & Alex Nelsen, OMS4, Burrell College of Osteopathic Medicine
The opioid crisis is undeniably relevant to us as health care workers in New Mexico. In 2017, New Mexico exceeded the national rate of opioid-involved overdose deaths at 16.7 deaths per 100,000 persons... “[and] deaths have not significantly changed over the last several years.”1With today’s medical model of increased productivity requirements, documentation, and new quality metrics, physicians may feel increased pressure to spend less and less time with their patients leading to lower thresholds of prescribing “quick-fix” solutions, like opioids. This, in turn, can contribute to devastating addiction. In an article by Fishbaine et al., it states,
“...abuse develops in nearly 5% of patients with chronic pain who are treated with prescription opioids, though this rate varies across studies."2
Using the principles of patience and advocacy, we can continue to use a fully holistic approach to improve patients’ lives and avoid potentially life threatening addiction. While our focus as osteopathic medical students has engendered positive outcomes here in New Mexico, we feel as if our anecdotal story can serve to help lower over-prescribing and perhaps remind all of us as to why we dedicated so much time to becoming physicians.
Recently, there was one specific incident during a surgery rotation where a patient presented with chronic pain. After several encounters and hospitalizations with negative objective findings, it would have been easy and timesaving to prescribe pain medications and monitor. Nonetheless, after collaborating with the surgeon, and beseeching a gastroenterologist to perform an endoscopic retrograde cholangiopancreatography (ERCP) despite no clear indication, an answer surfaced. Shortly after initiating the ERCP, it became unmistakable that this patient had a mass at the Ampulla of Vater causing his symptoms. Without advocating for the patient, and more importantly taking the time and having the necessary patience, this diagnosis may have been even further delayed and detrimental to the patient; who is currently undergoing chemotherapy and is doing well despite the circumstances.
One of the main reasons we have chosen to pursue careers as anesthesiologists lies in the opportunity to advocate for patients in their most vulnerable moments. Furthermore, we are eager for a career where we can implement our two additional suggestions to help attenuate the opioid crisis and earn patient trust in these vulnerable moments. The first way is through communicating with patients. According to the New Mexico Department of Health, risk factors for overdose include previous overdose, obtaining overlapping prescriptions, history of mental illness, and living in rural areas and having low income.3Good communication with patients at each visit should uncover these types of risk factors and help mitigate over-prescribing or prescribing to vulnerable patient populations. The second suggestion is to establish realistic expectations with patients. Opioids are used to minimize the body’s perception of pain, not cure pain. Patients’ expectations of having their pain disappear need to be addressed and normalized. Ultimately, we should advise patients that opioid prescriptions might not reduce their pain to the level they expect. Moreover, patients should be led toward strategies that manage their pain through a biopsychosocial model as opposed to relying on health care visits and medication to completely manage their symptoms.
We are thankful for an education that focuses on patients as humans; not only having bodies, but also minds and spirits. This knowledge instills in us a desire to take our time with everyone and find the causes of pain rather than simply mask the origin with symptomatic relief alone. We do recognize instances in which opioids may be appropriate, like palliative care or decreasing acute pain in rib fractures to avoid hypercarbia and we will continue to strive to do our part as medical students in this incredible profession of anesthesia.