General Health

The Other Side of the Opioid Epidemic

The number of opioid prescriptions per person in the U.S. peaked in 2010. And it has dropped every year since through 2015. This sounds encouraging, but according to the Centers for Disease Control and Prevention (CDC), the level in 2015 was still three times higher than in 1999. And while the U.S. makes up 5% of the world’s population, we consume 80% of the opioid pain relievers manufactured.

So, prescribers are becoming more and more reluctant to write prescriptions for the drugs for fear of investigation, or worse, prosecution and prison. This after increasing attention on the opioid epidemic that has led to policies aimed at curbing prescriptions and dosages, as well as insurers limiting the number of pills they’ll authorize.

In March 2016, the CDC issued stricter guidelines for doctors who prescribe opioids. The guidelines urge doctors to use caution when prescribing opioids at any dosage, especially when increasing dosages, including justifying dosages greater than 90MME per day.

Is this a case of throwing the baby out with the bathwater?

What About Chronic Pain Sufferers?

What about the patients for whom pain is genuine, and often chronic (estimated to be between 25-100 million people in the U.S.)? What about those whose need for pain relief is real? Chronic pain is the primary reason people go on disability. And in addition to overall quality of life, chronic pain negatively effects work, family, and social networks. According to an article posted on the Psychology Today website (11/24/2015), the suicide rate among people with chronic pain is known to be roughly twice that for people without chronic pain.

Is there an epidemic of chronic pain that’s getting little attention in the face of the opioid epidemic?

Chronic pain sufferers are often dependent on opioids to function and live normal day-to-day lives. But being dependent (in order to function) is not the same as being addicted.

Patients who have legitimate needs for opioids are finding it increasingly difficult to get access to their prescriptions; they experience everything from having to drive long distances to find providers willing to prescribe, to having to sign contracts, to being urine tested, to being tapered to lower doses than they need.

What’s the Answer?

These patients, and their doctors, say that the answer to the opioid epidemic is not taking away the medication of every patient out there. It’s addiction treatment. They say there are those who legitimately need pain medication as well as the many options for chronic pain management available to providers. Appropriate use of the correct intervention at the right time must be part of the conversation.

In Idaho, where a “Don’t Punish Pain” rally was held in Boise in March 2018, attendees wanted to have chronic pain sufferers added to a list of cancer and hospice patients. This would enable them to get their pain prescriptions without limitations. Protesters hope that future legislation reflects their needs.

But providers in Idaho write higher than the national average number of opioid prescriptions. According to the National Institute on Drug Abuse, in 2015, Idaho providers wrote 76.4 opioid prescriptions per 100 people. That’s approximately 1.3 million prescriptions. In the same year, the average U.S. rate was 70 opioid prescriptions per 100 people. And in some Idaho counties the rate is even higher.

In an April 2018 interview with CNN, the head of the U.S. Food and Drug Administration, Dr. Scott Gottlieb, suggested mandatory training on pain management and opioid prescribing for the nation’s physicians. He said that current standards are based on outdated training, which is not mandatory and that we need to “re-educate a generation of physicians.”

Idaho is already making efforts in that arena with prescriber education via University of Idaho’s ECHO Program. ECHO uses a team of specialists in a learning and guided practice model – communicating through video conferencing technology to connect with providers throughout the state to conduct virtual clinics. Its first clinic (bi-monthly March through September 2018) is focusing on opioid addiction and treatment. http://www.uidaho.edu/academics/wwami/echo

Chronic pain sufferers and the providers who treat them hope that the pendulum that has swung so far in one direction will come back toward center. They hope that with more research and increasing calls for mandatory education, not only in opioid prescribing but in pain management, the right balance of treating people who suffer from chronic pain will be achieved.

Idaho’s Rural Doctor Shortage

SHOSHONE – “Keith Davis became Lincoln County’s only doctor at the stroke of midnight.

It was a late summer night in 1985, and Davis had recently completed his residency, the last month of it spent working at Shoshone Family Medical Center. The center’s lone doctor, Royal “R.G.” Neher, M.D., was retiring, and he needed a replacement.

Davis had interviewed at clinics in slightly larger cities in Idaho and Washington. But neither city offered the same opportunity for long-term employment that Shoshone did. So when the clock chimed midnight on Aug. 1, Neher stepped down and Davis took his place.

On his first day, Dr. Davis saw 52 patients and delivered a baby with nurse practitioner Janet Sandy. Almost 33 years later, he and Sandy are still seeing patients together at their office on Apple Street. And almost 33 years later, Davis is still the only doctor in a county the size of Rhode Island.

With just one practicing physician, Lincoln County is one of seven counties in south-central Idaho that’s a federally designated Health Professional Shortage Area (HPSA) for primary care physicians. And it’s not just the Magic Valley – a recent report by the Association of American Medical Colleges placed Idaho 49th in the nation for the number of physicians per capita.

Camas, Cassia, Gooding, Jerome, Lincoln, Minidoka, and Twin Falls Counties are all HPSA-designated in primary care. Blaine County isn’t, but one of its towns, Carey, is. Low-income residents in Jerome and Gooding Counties are particularly underserved, according to data from the U.S. Department of Health and Human Services.

There aren’t necessarily fewer doctors today than in the past. Davis has been the only practicing doctor in Lincoln County for more than 30 years, and Neher ran a one-man operation there for decades before him. But as the average age of the rural Idaho physician increases – and many begin considering retirement – a new question has emerged: who will replace them, and how?”

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Children’s Dental Health Month

February is National Children’s Dental Health Month, so it’s a good time to remind everyone – adults and children alike – that your oral health is important to your overall health. Practicing good oral health habits such as daily brushing and flossing and regular dental visits are easy steps toward keeping teeth and gums healthy at every age.

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Dementia Caregivers – A New Training Curriculum

Back in September, on World Alzheimer’s Day, we addressed some general knowledge about Alzheimer’s and related dementias. We also talked about the number of people in Idaho suffering from the disease, the outlook, and some of the things being done about it.

Today 24,000 people in Idaho aged 65 and older have Alzheimer’s; in just eight years, that number is expected to climb to 33,000. It’s the sixth leading cause of death in Idaho. The Medicaid costs of caring for Alzheimer’s and dementia patients in Idaho in 2015 was $125 million; that number is expected to increase by 60% to $200 million by 2025.

Recently, the Health Resources & Services Administration (HRSA), which supports the training of health professionals in the United States, came out with some new training modules that focus on Alzheimer’s and related dementias. These are in addition to their basic dementia training curriculum and specifically address caregivers of People Living with Dementia (PLwD). According to their website, currently more than five million Americans live with Alzheimer’s disease. And ultimately, one out of every three Americans will die from Alzheimer’s disease or another dementia.

The 11 supplemental training modules are designed to help providers understand the needs of caregivers of PLwD (four modules) and to directly assist family and other caregivers take care of themselves and cope with the challenges of caring for PLwD (seven modules).

Modules for Providers:

Module 1: Providers and Caregivers as Allies

Module 2: The Provider’s Role in Shared Decision-Making with Caregivers, Families, and Persons Living with Dementia

Module 3: How Clinicians Can Interact Effectively with Caregivers

Module 4: Taking Care of Those Caring for Persons Living with Dementia

 

Modules for Caregivers:

Module 1: Caregiving for Persons Living with Dementia (Faculty Guide)

Module 2: The Caregiver Role in Shared Decision-Making with Persons Living with Dementia (Faculty Guide)

Module 2a: Assisted Living Facility Considerations (Faculty Guide)

Module 2b: What to Consider When Choosing a Nursing Home (Faculty Guide)

Module 3: Working with the Healthcare Team (Faculty Guide)

Module 4: Caregiver Self-Care (Faculty Guide)

Module 5: Addressing Behaviors in Dementia (Faculty Guide)

 

To access the learning modules, visit the HRSA website at https://bhw.hrsa.gov/grants/geriatrics/alzheimers-curriculum?utm_campaign=enews12072017&utm_medium=email&utm_source=govdelivery 

To read more General Health articles, click here.

ParkRx and the Eco-Therapy Movement

You’ve probably heard of psychotherapy, equine therapy, and group therapy, but what about ecotherapy? Ecotherapy is a nationwide trend that’s working to add one more tool to the array healthcare providers use to integrate care across the medical health neighborhood. The philosophy behind the trend is that prescribing specific interactions with nature like walking and exploring local parks will benefit patients with chronic conditions such as depression, diabetes, obesity, high blood pressure, and ADHD. It’s gaining acceptance in mainstream medicine and carrying more weight with patients when prescribed by a doctor.

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Influenza Immunization: Continuing Education Credit Opportunity

The National Foundation for Infectious Diseases (NFID) has partnered with mdBriefCase Group Inc. to offer a complimentary online Continuing Medical Education (CME) activity offering strategies to help prevent influenza in patients age 65 years and older. This on-demand program provides a framework for counseling adults age 65 years and older on the importance of annual influenza vaccination through case-based scenarios and can benefit all providers in all task areas.

Upon completion of this activity, participants will be able to:

  • Describe the benefit of influenza vaccination in adults age 65 years and older
  • List the vaccine options available for seasonal influenza vaccination of adults age 65 years and older
  • Differentiate vaccine products approved for seasonal influenza in adults age 65 years and older
  • Effectively counsel older adult patients about the importance of seasonal influenza vaccination
  • Please note that participants will be required to create an mdBriefCase account to access the online program, but there is no fee to participate in this activity.

If interested, the program can be accessed at Influenza Prevention Strategies.

National Influenza Vaccination Week

National Influenza Vaccination Week: December 3-9, 2017

National Influenza Vaccination Week (NIVW) is a national awareness week to remind everyone six months and older that it’s not too late to get a flu vaccine. NIVW is a national observance established in 2005 by the Centers for Disease Control and Prevention (CDC) to highlight the importance of continuing influenza vaccination after the holiday season and beyond.

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November – National Diabetes Awareness Month

This is a reprint of a November 9th article in Headline News which is a publication of the Idaho Department of Health and Welfare.

Diabetes is a huge health problem for so many here in Idaho: Nearly 600,000 Idaho adults have prediabetes and are at risk for developing type 2 diabetes, according to the Centers for Disease Control and Prevention.  The American Diabetes Association reports that around 8 million Americans have diabetes and many don’t know it. November is Diabetes Awareness Month, so it’s a good time to learn what you can do to prevent the disease or get help managing it.

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