3 Day scripts a good idea?
With Governor Hogan’s Heroin and Opioid Prevention, Treatment and Enforcement Initiative being announced in early 2017 there has been a lot of talk recently about the appropriate number of days a narcotic prescription should been written for.
An informative and timely article, dated January 28 2017, written in the Frederick News Post by Frederick physician Dr. Julio Menocal, addressed many of the issues relating to narcotics and opioids prescribing he suggested that a 3 day rule be instituted. One of our Frederick and Leesburg based pain doctors Dr. Chirag Sanghvi and our senior staff have pondered this suggestion.
The opioid epidemic is a very real concern. As the Surgeon General pointed out in his letter to physicians dated August 25 2016, “Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”
However, expecting your internal medicine/ primary care physician to have the tools to manage genuine long-term chronic pain is unreasonable considering the huge variety of ailments they skillfully treat and juggle daily.
What are the unintended consequences of the 3 day narcotic/ opioid script?
There are many complexities involved in treating pain responsibly. The proposed three-day rule certainly addresses the need for increased monitoring of opioid and narcotic prescriptions.
However, will this rule itself achieve the desired outcome?
With the assumption that terminally ill patients, such as patients with cancer, would not be subjected to the three-day restrictions we must also look at the unintended consequences this rule may trigger:
- Large burdens on waiting rooms and provider schedules as patients fill the books with prescription refill, UDS screen and pill count appointments,
- Additional monthly cost for patients who pay co-pays for every visit,
- Increase in overall health care costs (which may be passed on to all patients eventually),
- Emotional stress on genuine patients who feel they are being treated like drug seekers.
- Potential for increased incidences of “doctor shopping” in neighboring states
- Potential increased theft of medications and break-ins,
- Increase in use of heroin and alternative drugs as opioids become more difficult to obtain.
The three-day rule is certainly a conversation to be had, but perhaps equally as relevant is exploring alternative pain treatments.
Are we taking the right approach?
Many people do not realize that pain management is a specialty itself and is offered as a separate board-certification.
Unfortunately, most people seek specialist pain management care after having suffered with chronic pain for a long time and seeing physicians whose therapies are limited to pain medications.
Chronic pain along with prolonged use of narcotics causes multiple changes in the body such as changes in normal levels of circulating hormones and sleep cycles. These chronic physiologic changes can cause mood changes along with changes to how our bodies perceive pain.
The good news is that there are many alternative pain treatments available. In most cases successful pain management utilizes an integrated approach that encompasses a combination of treatments.
As physicians we recognize that the opioid epidemic is a very real and serious situation. As board-certified interventional pain specialists we also recognize there is a need to treat genuine pain responsibly.
We therefore recommend;
- Using non-surgical, interventional procedures to immediately and effectively reduce pain levels.
- In cases where medication management is necessary; reduce reliance on pharmacologic substances, maintain low doses and do not limit “pain medicine” to strong opioids & narcotics,
- Outline a detailed and carefully designed treatment plan that takes a multi-modal approach to include: weight-loss, chiropractic, physical therapy and/or counselling.
These therapeutic interventions (procedures) work extremely well at the onset of pain when other physiologic changes have not yet occurred in the body and there is less damage to reverse.
Therefore, the earlier a patient seeks specialist care for their pain the less likely that patient is to be placed on a long-term medication schedule.