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Prescription Drug Abuse – The Physician’s Perspective

By Katie Galyean

Prescription_Drug_AbusePrescription drug abuse is becoming a major problem in both rural and urban North Carolina. Bladen Online is taking a closer look at Prescription drug abuse in Bladen County. This is the third in a series of stories more closely examining the issue.

According to a survey conducted by the National Safety Council, 74 percent of doctors believe that opioids, such as oxycodone or morphine, are the most effective way to treat pain. However, other studies done by the National Safety Council show that over the counter pain medication are often far more effective in relieving acute pain.

Kailash Chandwani, a physician employed at the Southeastern Spine and Pain Clinic in Lumberton, NC, disagrees with the 74 percent of doctors in his profession. When prescribing pain medication of that magnitude, Chandwani talks them through the reasons they should not take the pills for long.

“My discussion starts with there is really no hard evidence supporting the long-term use of opioids in pain management,” said Chandwani. “It is an important treatment, but we have to use it safely and appropriately in conjunction with other treatment modalities.”

When asked why doctors continue to prescribe so much medication over an extended amount of time even though studies show that it does not help the patient, Chandwani explained that a few decades ago, there was a movement called the Chronic Pain Crisis, which stemmed from concerns about the lack of pain management.

According to Chadwani, in an effort to adequately treat the chronic pain, health care organizations and other medical industries started pushing for physicians to prescribe medication liberally. “Unfortunately, we saw the surge in the rates of morbidity and mortality with unlimited use of the opioids without seeing any additional benefit from increasing the rate of the opioid prescription,” he said.

Part 1: A Pharmacist’s Struggle
Part 2: The Addict’s Burden

However, according to Chandwani, many doctors do not prescribe liberally just because the can, but because they feel pressured to. Patient satisfaction is extremely important in the medical field as it directly relates to the industry’s funding. “Sometimes, I feel like I’m walking a tight rope,” said Chandwani.

Chandwani did say both of these situations are getting much better.

The newest guidelines published by the Center for Disease Control recommends prescribing the lowest effective dose rather than the entire bottle of pills and the center for Medicaid and Medicare is planning to eliminate the patient satisfaction questionnaire when it comes to pain management related satisfaction.

“We don’t feel pressured to prescribe the pain medication. That is very positive. You will see the difference in the ER practices or the private practices, you will see the difference,” said Chandwani.

Chandwani said he prefers to treat his patients with alternative pain management before he prescribes any type of opioids. These other treatments include physical therapy and at-home exercising regiments.

Recognizing that many people legitimately need to take the stronger medication, Chandwani has safety measures put in place at his practice to help protect his patients. He prescribes the medication in small doses, designed to take no longer than a week to consume.

“[We do] pill counts, where the remaining pills [are brought in] so we can count them and we do regular urine screens, sometimes we call them at random for a random urine drug screen,” said Chandwani.

Chandwani said he and the other medical professionals at his practice often have to interact with people who are addicted to prescription drugs. “In the rural counties of the Carolinas, we are seeing just crisis, opioid crisis,” he said.

Chandwani has been working to create more awareness about the current prescription drug abuse problem. “In my practice… the goal was to really raise awareness of the problem, the scope of the problem. The other goal was how to prescribe safely and rationally,” said Chandwani.

Chandwani’s advice to other doctors is to establish the diagnosis first thing and then maximize on other resources other than the pills to manage the pain before prescribing. If the doctor does have to prescribe the pills, Chandwani suggests giving the patient to more than a week’s worth of supply.

“The more you prescribe, the more you are trying to make them dependent and that’s where you are setting the path for addiction,” said Chandwani.

Having an exit strategy to get off of the medication was also high on Chandwani’s list. “Once the pain in question has been addressed or is not responding to the current medication regiment, we should activate the exit strategy instead of escalating the doses, which hasn’t been shown to improve the outcome, rather it causes more harm,” he said.

Chandwani also warned that doctors should be vigilant to check the national prescription drug monitoring system before prescribing to a patient. The system is a database that lists how much medication is being prescribed and who is prescribing it for each patient.

According to an article in the Charlotte Observer written this past February, this database is only used about 6 percent of the time.

Chandwani was adamant about the importance of helping those who have become addicted to prescription drugs.

“We have to treat those people like they are people, like a human being. We cannot just let them go and we have to treat them with dignity and respect. We have to set them up with mental health care or the addiction recovery services, whatever other resources we have here in order to get them off those pain medications,” Chandwani said.

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