Area health providers create practices to battle opioid addiction, abuse

May 21--JANESVILLE -- Local doctors agreed they have a role to play in addressing the problem of painkiller addiction that can lead to heroin use, but they said law enforcement, insurance companies and community members are part of the answer, too.

"This is one area where there is broad unanimity among physicians that this is a problem we need to address, but none of us have perfect answers for this," said Dr. David Murdy, a physician at Dean Clinic-Janesville East.

"The more we work together as a community, the fewer patients with problems we have."

The Wisconsin medical community is modifying its prescribing practices, and new legislation mandates a state database to collect information about opioid prescriptions.

"There was a perception in our community that prescription medicines weren't as risky as heroin, and that needs to change," Murdy said. "People need to realize these medicines are risky."

Opioids, including heroin and prescription narcotic pain relievers, in 2014 killed nearly 19,000 people nationally, the most ever, according to the federal Centers for Disease Control.

In Wisconsin, opioid medications such as oxycodone, hydrocodone and methadone contributed to more deaths than heroin between 1999 and 2013, according to the Wisconsin Department of Justice.

The prescription opioids led to 382 of the 843 overdose deaths tied to drugs in 2013 in Wisconsin. Heroin contributed to 226 deaths, according to the department of justice.

DRUG SOURCES

People are buying the medications on the streets, stealing them from medicine cabinets, getting them from family members or friends or are abusing doctor prescriptions, according to medical and law enforcement professionals interviewed by The Gazette.

Murdy, who has practiced internal medicine in Janesville since 1987, said the vast majority of people who switch from pain medicine to heroin aren't people prescribed the medicine. Instead, they steal it from others or they buy it illegally.

Murdy said he doubted more than 20 percent of people who abuse prescription pain relievers were prescribed the medication, but he estimated 80 percent of people who use heroin started on prescription pain meds.

Rock County Sheriff's Office Capt. Todd Christiansen said people the sheriff's office has come across often buy pills on the street or steal them from people with prescriptions.

Janesville police Sgt. Chad Pearson said investigators see people with prescriptions for painkillers giving pills to family members who are addicted but can no longer get prescriptions because they've been flagged by law enforcement or health providers.

Murdy, who is Rock County Medical Society President and a member of the Wisconsin Medical Society Opioid Task Force, said doctors approach such situations "with great anxiety and difficulty."

"Our bias is to be on the side of the patient," Murdy said. "I'm not saying I would condone that type of practice. I would want patients to be approaching physicians honestly. ...I can't say that those types of things don't happen but hopefully with better prescribing on doctors' parts, it happens less often."

Murdy said he agrees with the American Medical Association's stance that part of the solution to the opioid problem is prescribing less and educating doctors and patients more on the risks associated with the substances while keeping patient care the priority.

ADJUSTING GUIDELINES

Wisconsin hospitals for years have been developing or modifying their prescribing and monitoring practices based on national guidelines, other states' initiatives and Wisconsin Examining Board suggestions, Murdy said.

At Mercy Pain Center and St. Mary's Janesville Hospital and Dean Clinic, patients with prescriptions for narcotic medications have their pills counted at visits, complete urine tests, and are educated about the risks to themselves and the community associated with prescription pain medicine.

The providers prescribe narcotic pain medication after alternative methods--physical therapy, water aerobics, yoga or non-narcotic pain relievers--have been discussed and specialists have been consulted on the treatment plan.

Three years ago, Dean and St. Mary's began having patients enter pain medication agreements, Murdy said. The agreements commit patients to using the medications properly, attending ordered appointments and understanding refills happen only when prescriptions reach their refill dates.

Mercy Pain Centers has such agreements, too, said Dr. Jaymin Shah, pain center medical director.

Doctors try to start with lower doses of narcotics and increase doses if needed at follow-ups, Shah said. Mercy Pain Centers has patients come in at least once a month for checkups, Shah said.

Shah could not speak to the practices of all Mercyhealth physicians for prescribing pain medicine, but said he thinks "everyone tries to do the best for the patients" and is unaware of "anyone who is a big pill pusher."

In a written statement, Barb Bortner, Mercyhealth vice president, said all Mercyhealth physicians follow federal Centers for Disease Control guidelines for treating pain and prescribing pain medications. She said they use prescription drug monitoring programs to help regularly screen patients, and monitor and evaluate patients needing opioid medications.

Over the last three years, Dean and St. Mary's have upped the frequency of patient follow-up appointments required for patients with chronic pain using prescription pain medicine. This allows for better monitoring of a medicine's effectiveness and need. Patients come in every month or every three months compared to every six months, Murdy said.

The appointments could become more frequent as more guidelines and regulations are created at a state and national level, Murdy said.

Murdy said physicians are working to reduce the number of medications prescribed by combining non-narcotic medications and other treatment options and reducing the length of subscriptions.

The goal is to treat pain while considering insurance coverage, treatment options and patients wants and needs, doctors said.

Shah said pain medications provide 20 to 30 percent relief, not the complete relief some people expect. He said better compliance will come when people realize complete relief is reached with care such as exercise or physical therapy, non-narcotic pain relievers such as Tylenol and pain killers used on an as-needed basis.

NEW STATE REQUIREMENTS

As part of state legislation aimed at curbing opioid abuse, doctors will be required to look at a database of opiate drug prescriptions before writing new prescriptions for painkillers.

The requirement is part of a legislation package Gov. Scott Walker signed into law in March.

Rep. Debra Kolste, D-Janesville, co-authored the legislation. She said access to and abuse of opioids is proven to lead to heroin addiction.

Kolste has reviewed statistics showing the number of opioid prescriptions has skyrocketed since 2000 because of monetary incentives for hospitals and insurance companies to treat pain with narcotics, she said.

The new legislation requires law enforcement officers to upload information to the database when they find evidence of prescription drugs being abused or stolen.

"You have to get all stakeholders on the same page," Kolste said.

Doctors and nurses use the database regularly because pharmacies already input information on prescriptions, Shah and Murdy said. The two said providers are looking forward to April 2017 when an updated version of the software folds in law enforcement comments.

"The access to that information is critical," Shah said.

TEAM EFFORT

Christiansen and Pearson said they come across more heroin abuse than prescription pain medicine abuse, but they are convinced the two are connected. Prescription opiates have a similar high to heroin, but heroin can be cheaper, Christiansen said.

Law enforcement and hospitals are working together to tackle the opioid addiction with training, meetings and sharing information with the public, Christiansen and Pearson said.

Doctors can't be the only ones to help stop opioid abuse because no plan is foolproof, Shah said. He said community members have to pay attention to the risks, and there needs to be more substance abuse programs and prescription drug drop-off boxes.

"A lot of times it's not just the physician," Shah said. "It's also the communities we live in and expectations that we should have no pain and pills will fix us.

"The other thing people forget is heroin is easier to get, sometimes, than pain pills, so unless the community does something to stop that, we are just going to try and make it more difficult."

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