Physician Perspective

MT Physicians Stand Tall in Know Your Dose Campaign

CMC Breast Cancer Cernter

Prescription drug abuse and diversion is an epidemic – it affects everyone, and the statistics are staggering. Not enough Montanans are aware of the number of lives lost, making prescription painkillers 15 times more deadly than heroine, meth and cocaine combined.

Marc Mentel, D.O. was recently interviewed on Voices of Montana regarding this campaign click play below to listen in.  The Montana Medical Association thanks the Northern News Network for their help in promoting the KnowYourDoseMT.org initiative.

 

 

As physicians, we are committed to providing compassionate care to our patients following best medical practices.  There is not a pill for every ill.   When it comes to the management of chronic pain this is a truth, a tough pill to swallow.  The MMA is committed to being a positive resource that will encourage more physicians to take on the challenge of treating patients with chronic pain, so that access to care following current “best practices” will be improved, not restricted. With the tools and education on pain management and safe opioid prescribing found on knowyourdosemt.org, physicians and health care providers can be confident in their treatment of patients suffering from pain. We can ethically and reasonably care for patients and help get them to a better place in their life by following safer prescribing practices, monitoring and documenting. As medical best practices evolve bringing new knowledge to light that improves our ability to care for our patients, this website will evolve.

According to the MT Department of Public Health and Human Services, prescription drug overdoses were responsible for at least 369 deaths and more than 7200 hospital inpatient admissions and emergency department encounters in 2013 in our state. The consequences impact our families and friends, the communities we live in, and our workplaces. It also fills our physician offices and emergency departments.  The MMA and our partners are committed to providing resources and education to help fight this epidemic while providing needed medical care through our Know Your Dose initiative.

We are committed to playing a pivotal role and applaud our partners — pharmacists, nurses, dentists, public health, and law enforcement officers who are equally committed to tackling the public health crisis of prescription drug abuse.  We offer our gratitude to the Montana Medical Association Foundation, Blue Cross Blue Shield of Montana and Montana Department of Justice for providing resources, and to the Northern News Network for increasing awareness about this initiative.

It’s timely for others to step forward in support and for the general public to become more engaged.  You can be a partner in reducing supply and stopping diversion by not sharing your medications, securing and disposing unused prescription drugs and watching for signs of diversion.  We encourage you to join the fight in ending opioid abuse.  Start the conversation in your community.  Visit www.knowyourdosemt.org to make a donation and learn about this initiative.

Missoula – Marc Mentel, D.O., Montana Medical Association Prescription Drug Abuse Reduction Chair

MMA Vice President, William Gallea, M.D. – Speaks on Difficulty Treating Chronic Pain

The end of July marked the launch of www.knowyourdosemt.org. The resources now available are a result of the work put forth by many physicians and other health care providers serving on MMA’s Prescription Drug Abuse Reduction Committee. It includes an educational module and a health care provider toolkit containing downloadable forms available at no cost.

The launch started in Billings and ended the following day after its promotion in four towns across Montana. Doctor Bill Gallea, MMA Vice President made a call to have physicians, health care providers and the public help attack this public health crisis in Helena, Montana.

Contact the MMA Executive Office to learn how you can promote The Know Your Dose initiative in your community at mmaoffice@mmaoffice.org.

Course Intended For All Specialties: Physicians, Dentists, Physician’s Assistants, Pharmacists, Nurses, Nurse Practitioners, Advanced Practice Nurses
Course Objectives:

  • Implement recommended prescribing practices and alternate forms of treatment for patients presenting with acute or chronic pain.
  • Use the toolkit and resources to manage patient treatment.
  • Apply the state and federal laws as related to prescribing Schedule II drugs.
  • Examine the prescription drug issue from a state and national level.

Access the Know Your Dose Medical Education Course.

Opiates: The Silent Epidemic

(Submitted in January, 2014)

Currently there is an epidemic sweeping this country at an unprecedented rate. The epidemic is prescription opiates. Approximately 50 people die every day from prescription opiates. Put  another way, if compared to all wars fought by the United States, the death toll from prescription opiates would be the third deadliest campaign in US history. The only wars with more casualties would be the Civil War and World War II. If this trend continues, in about 10 years the number of casualties will exceed World II at more than a half million dead.

So how did we get here? Starting around the late 90’s and into the 21st century, pain as the 5th vital sign was starting to be monitored by health care professionals. Patients who were in chronic pain were asked to rate their pain on a scale of 1-10. Pain greater than a four on this scale was deemed undesirable and would require treatment. Patients were then started on medications to alleviate pain, and opiates were the first and most common choice by many providers. Since then, physicians, dentists, nurse practitioners and physician assistants now prescribe 4-5 times the amount of opiates they did 10 years ago. Currently, there are enough opiates prescribed that every US citizen over the age of 18 could take 5mg of Lortab every four hours for the next month. We could all go on national holiday.

Over the past decade of my practice, I have witnessed the effects of monitoring pain as the 5th vital sign. I have seen children who are now being raised by their grandparents because both mom and dad overdosed on prescription Methadone. Newborns being admitted to Neonatal Intensive Care Units to withdraw from opiates for the next 4-6 weeks because mom was dependent on Lortab. Grandparents who will never see their grandchildren open Christmas presents because they themselves were on too high a dose of Fentanyl patches to wake up. Teenagers who will never graduate from high school, because they took some of mom’s perks and died in a head on collision.

For a little over a year-and-a-half, I have been actively working with our organization’s Malpractice Insurance Carrier, promoting a plan called Community Safe Prescriber. I have had the privilege to speak to some of the other organizations who share the same Malpractice Carrier in the Rocky Mountain Region. I usually begin my presentation by asking three simple questions of the providers present. Number one, how many of you have cured patients of their chronic pain with the use of prescription opiates? Number two, how many of you enjoy treating chronic pain with opiates? Number three, how many of you know somebody or someone that has died from an opiate overdose? The answers are always the same, whether I am in Nebraska, Wyoming or somewhere in Montana. Not surprisingly, I have yet to have anyone raise their hand to the first two questions. Sadly, I have yet to have anyone keep their hand down to the last question.

As a physician, I find this troublesome. I took an oath to do no harm.  If I took an oath to do no harm, why should anyone die from prescription opiates? Is the collateral damage of treating chronic non-cancer pain worth the price? Especially when there is mounting evidence that patients on chronic opiates usually have a poorer quality of life and life expectancy, when compared to those treated by other means. I don’t believe that prescribing opiates was the original intention of monitoring pain as the 5th vital sign. I believe the original intention was to monitor and search out the cause of the pain and treat accordingly. Contrary to popular belief, opiates are not a cure for chronic non-cancer pain. In fact, opiates may make pain worse in some cases. To date, there is no cure for chronic non-cancer pain.

Where do we go from here? Chronic non-cancer pain is very real and patients will do whatever they can to rid themselves of this ever present demon. However, adding the lifelong sentence of opiates may be another demon they were not expecting. In my opinion, to treat patients appropriately, and to stem the current epidemic, it will take a change of current prescribing patterns and patient and provider responsibilities. Providers need to monitor patients on a routine basis with follow up visits and periodic urine monitoring to ensure patients are kept safe. Patients will need to keep their medications secure so that it can’t get into the wrong hands. The health care community at large will need to be involved in educating their citizens about the dangers of opiates. However, before any of the above can occur, we must first acknowledge this silent epidemic exists and give it a voice.

— Mark Mentel, D.O., Community Medical Center, Missoula

PRESCRIPTION ABUSE PREVENTION