APM Blog


Prescription-Drug-Abuse (2)

01 Nov
Dr. Jeremy Scarlett
  Dr. Jeremy Scarlett

Prescription drug abuse has been a hot topic for years, and never more so than right now. Several presidential candidates – including Carly Fiorina, Jeb Bush and Chris Christie – have made drug treatment a standard part of their stump speeches and virtually all candidates have touched on it. The issue is even hotter here in east central Wisconsin, where a local physician recently had his license suspended (and may face criminal charges) as a result of DEA investigation into over-prescription.

This is certainly an important discussion. Last year, more than 16,000 Americans suffered fatal overdoses of prescription pain medications (opioids) and an astounding 420,000 visited emergency rooms for misusing them. And those numbers are only the tip of the iceberg. Most medical professionals acknowledge there is a direct link between the abuse of prescription opioids like OxyContin and Percocet and opiates like heroin. All too often, patients first develop an addiction to legally prescribed pills and then switch to heroin after their prescription lapses or they simply run out of money (since heroin is cheaper).

We are slowly making progress in the fight against this epidemic. I am encouraged that lawmakers are recognizing the opioid/opiate connection and calling for increased treatment and education programs. Here in Wisconsin, the HOPE (Heroin, Opiate Prevention & Education) laws were a great step forward, as is recent legislation aimed at increasing access to the counter-overdose drug naloxone. Another aspect of the HOPE laws now requires all licensed providers check the State’s Prescription Drug Monitoring Program before prescribing opioids to patients. This is critically important because it will facilitate better communication between providers and prevent patients from “doctor shopping” for medications.

While these are all important aspects of the issue, there has been one thing noticeably missing from the discussion: the need for America’s medical system to shift its emphasis away from opioid pain treatments in the first place. Opioids do have a role in the spectrum of care, but they are best reserved for a short-term solution. At my organization’s clinics, our first step with patients is to guide them into long-term lifestyle modifications that help prevent injury, illness and other causes of chronic pain. We also provide patients with long-term medical solutions through minimally invasive procedures like intrathecal pump implants (which use 1/300 the opioids as some oral therapies); as well as radiofrequency ablation and spinal cord stimulation, which can reduce pain enough to discontinue opioids altogether. In the shorter term, we typically opt for non-opioid treatments like epidural steroid injections to provide patients a “bridge” to recovery. Beyond our minimally invasive interventions, we believe that patients should at least explore the surgical option prior to exposing themselves to the risks of long-term narcotics.

I’m not suggesting that we do away with opioids entirely, however; they do have their place on a short-term basis and in responsible doses for patients who’ve tried other approaches to no avail. However, in those cases, safeguards like narcotic agreements, pill counts and toxicology screenings must be in place. 

Unfortunately, some of the best long-term solutions (like physical therapy and behavior modification) take time to deliver results. In the immediate gratification culture of American society, we’ve become overly reliant on the quick fix provided by opioids. Medical providers must challenge their patients by counseling them on the dangers and limitations of opioids and advocating for long-term solutions through interventional procedures and lifestyle changes.

As we move further into the presidential campaign, we will likely move further into this important national discourse – and that is great. I just hope we don’t continue to miss the most important piece of the discussion.

This guest editorial by Dr. Jeremy Scarlett appeared in Gannett newspapers in November 2015.


01 Nov

The U.S. Drug Enforcement Administration’s recent announcement that Milwaukee will be one of four cities to take part in their “360 Degree Strategy” anti-heroin pilot program is certainly a welcome development. Although Wisconsin has been ahead of the curve in heroin and prescription drug abuse prevention, these two inter-related problems remain huge issues here – as evidenced by the 72% increase in heroin overdoses in Milwaukee County since 2013.

Dr. Jeremy Scarlett
  Dr. Jeremy Scarlett

More ominously, heroin use (which typically starts with misuse of prescription opioids) almost certainly plays a role in the precipitous rise of drug-related violence and homicides in the area. The DEA is correct in recognizing the link between opioid/heroin abuse, criminal gangs and drug cartels and the cycle of violence it creates. This is a downward spiral we must stop.

I hope that all medical providers will actively engage with the DEA on this important program. I know that my organization is committed to doing that, as well as supporting state-level initiatives such as the HOPE (Heroin, Opiate, Prevention and Education) Laws and Attorney General Schimel’s “Dose of Reality” campaign. On the peer-to-peer level, we will continue to sponsor statewide professional education events on responsible prescribing practices, including how to spot patients who are abusing or are likely to abuse in the future.

While we firmly believe that opioids do have a place in the spectrum of medical care, they should only be used on a short-term basis and in responsible doses for patients who’ve tried other approaches to no avail. This approach includes safeguards like narcotic agreements, pill counts and toxicology screenings.

Unfortunately, some patients are resistant to this approach. In the immediate gratification culture of American society, many want to forego long-term solutions in favor of the quick fix provided by opioids. We urge medical providers to challenge their patients by counseling them on the dangers and limitations of opioids and advocating for long-term solutions through interventional procedures and lifestyle changes.

I applaud the DEA for spotlighting the symbiotic relationship between prescription drug abuse, heroin and violent crime – and for choosing Milwaukee to help launch this important program. In this time of partisan divisions and acrimonious public discourse, the 360 Degree Strategy should be something that everyone in the community – from medical professionals to law enforcement to the general public – can wholeheartedly support.  

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