By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD
March 14, 2018
The opioid epidemic is in the news on a daily basis. Do optometrists have a role in managing this crisis in the care and education they provide to patients? Here are some of the ways this epidemic may impact your practice.
More than 40 people are dying daily from opioid overdoses. There have been over 165,000 deaths from opioid overdoses since 1999. Over 4 million Americans are engaged in non-medical use of opioids. You can see that the problem is large and dangerous.
Beginning in the late 1990s healthcare providers began to prescribe opioids at greater rates. This led to widespread misuse of opioids before it was evident that these medications could be highly addictive. In 2017, Department of Health and Human Services declared a public health emergency and announced a five-point strategy to combat the opioid crisis.
The strategies are:
1) Improving access to treatment and recovery services;
2) Promoting use of overdose-reversing drugs;
3) Strengthening our understanding of the epidemic through better public health surveillance;
4) Providing support for cutting-edge research on pain and addiction; and
5) Advancing better practices for pain management.
The American Optometric Association (AOA) issued clinical recommendations for optometry’s role in the opioid epidemic. You can read that document HERE.
What can we do?
It is important to recognize when a patient is taking an opioid drug. Opioid medications include:
• Codeine
• Fentanyl (available as a synthetic drug patch)
• Hydrocodone
• Hydrocodone/Acetaminophen
• Hydromorphone
• Meperidine
• Methadone
• Morphine
• Oxycodone
• Oxycodone and Acetaminophen
• Oxycodone and Naloxone
Patients won’t always tell us they are taking opioids, so we need to know what to look for. Patients taking opioid drugs may present in the office with any of the following symptoms:
• Diarrhea
• Nausea
• Vomiting
• Muscle pain
• Anxiety
• Irritability
• Sensitivity to pain
• Constipation
• Respiratory depression
• Dry mouth
• Sleepiness, sedation, dizziness
• Confusion
• Depression
• Low sex drive, energy, and strength (due to low levels of testosterone)
• Itching and sweating
The CDC released guidelines for all physicians for opioids. There are three overarching principles guiding the CDC guidelines. (We could use slight variations of these principles for all medications we prescribe.) These principles are:
1) Non-opioid therapy is preferred for chronic pain (outside of active cancer, palliative and end-of-life care).
2) The lowest possible effective opioid dosage should be prescribed.
3) Always exercise caution when prescribing opioids and monitor all patients closely.
The actual CDC guidelines are:
1) Opioids are not first-line therapy
2) Establish goals for pain and function
3) Discuss risks and benefits
4) Use immediate-release opioids when starting
5) Use the lowest effective dose
6) Prescribe short durations for acute pain
7) Evaluate benefits and harms frequently
8) Use strategies to mitigate risk
9) Review state prescription drug monitoring program data to determine whether the patient is receiving opioids
10) Use urine drug testing
11) Avoid concurrent opioid and benzodiazepine prescribing
12) Offer treatment for opioid use disorder
It is our responsibility to make sure our patients are managing their medications appropriately. We cannot avoid the opioid epidemic. We must all do our part to help our patients live a higher quality of life.
References
i. Department of Health & Human Services
ii. https://www.hhs.gov/about/leadership/secretary/speeches/2017-speeches/secretary-price-announces-hhs-strategy-for-fighting-opioid-crisis/index.html
iii. https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-a.pdf
