Safe Opioid Prescribing: A Focus on Patient Wellness

by Julianna Reece, MD, MPH, MBA, Chief Medical Officer for the Albuquerque Area Indian Health Service and Vice-Chair of the IHS Heroin, Opioids, and Pain Efforts Committee

October 31, 2019

The Indian Health Service is committed to improving the way we manage pain.
We have made a commitment to better understand our patients, to better
support our prescribers and to create an infrastructure that allows us to
safely and effectively reduce pain and improve function and quality of life
for our patients. The IHS opioid strategy has been deliberately aligned
with the National Pain Strategy and the HHS Opioid Strategy.

The
U.S. Department of Health and Human Services
has recently released a guide for clinicians on the
Appropriate Dose Reduction of Long-Term Opioid Analgesics
. This guidance focuses on the need for individualized, coordinated, and
patient-centered care plans when the decision is made between the provider
and the patient to reduce the dose of long-term opioid pain medications.

As a primary care physician, I understand the need for individualized,
patient-centered plans. I have seen many patients wanting relief from their
pain. I find that many people believe pain medications are the best way to
alleviate pain. As clinicians, our job is to work with the patient to
identify the pain, understand the pain, and work together to find a way to
relieve suffering and start healing.

Once we can establish a foundation of trust and respect, it is easier to
hear the patient and to get to the root of the issue. For example, some
patients have pain from simple injuries that were never rehabilitated
adequately, some have pain that started in one place and has spread, and
others had severe, life altering events that resulted in compromised
movement and decreased energy.

I recall I once had a patient with chronic pain due to a debilitating
disease. She was frustrated after seeing a number of specialists and
finally found a regimen that she felt worked for her. However, the numerous
amount of opioids prescribed to her for pain caused many side effects. I
took the time to discuss her concerns and I tried to help her understand
why her current regimen was dangerous for her. We discussed her treatment
plans and goals and the possibility of trying alternative treatments,
including tapering her use of narcotic pain medications. After several
months, she demanded more pain medication and eventually started seeing a
different physician. Thinking about how she was doing prompted me to learn
as much as I could about how to manage chronic pain and prevent the misuse
of opioids.

A year later, I saw her again and she told me she was off narcotics and
doing better than ever before. She explained that she was previously in
denial about her addiction. I was happy to hear that she saved all the
plans we discussed and took the time to research and understand her
addiction and pain. She eventually checked herself into rehab and started
to eat healthier, sleep more, and exercise every day.

I remember her often and keep this in mind when I have complex, emotional
discussions with patients. Pain is a very personal experience involving a
multitude of factors such as childhood background, mental aptitude, social
environment, and personal beliefs and values can affect perceptions of
pain. As providers, we need to meet our patients where they are, not where
we want them to be. Our goal is to work together to be healthier.

So for this autumn, let’s make a commitment to the preservation of life, to
the cultivation of safety and to reconnect with ourselves as we go into
this next winter.

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