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Opioid crisis surfacing at alarming rate locally

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Dr. Kevin Whitney, crossing Rivers emergency room medical director, sees at least three to four people, per 12-hour shift, who are regular opioid users and, in some cases, addicts. He has been part of the change in the tide in “prescribing” lifestyle improvements such as exercise and healthy eating to address pain and combat the opioid abuse crisis. (Photo by Correne Martin)

Crawford County Sheriff Dale McCullick (left) and Prairie du Chien Police Chief Chad Abram stand behind the prescription drug drop box that was installed inside the sheriff’s department in late 2013 as a safe, 24/7 drop-off point for prescriptions. The public is encouraged to continue to use this collection box as a way to keep opioids out of the hands of abusers (File photo)

By Correne Martin

Ten to 15 years ago, there was a big push to address health care patients’ pain and bring it down to a level of zero. As a result, prescribing opioids, or narcotics, became ordinary, and painkiller addiction became a crisis. Today, there is a movement that discourages use of such drugs as the solution for chronic pain.

Dr. Kevin Whitney, emergency room medical director at Crossing Rivers Health in Prairie du Chien, said the hospital sees at least three to four people, per 12-hour shift, who are regular opioid users and, in some cases, addicts.

“In the last six years, we’ve seen a significant escalation of overdoses and untimely deaths from this particular group of medicines. We see people tending to seek it more on a regular basis,” Dr. Whitney elaborated. “You see it being used inappropriately where people aren’t getting prescriptions for it. They’re buying it on the street or from other sources, not only in health care but through our law enforcement and school,s too. It’s morphed into a really dramatic and negative impact on many areas of our society.”

Crawford County Sheriff Dale McCullick said the jail is overcrowded with substance abuse addicts and there’s little law enforcement can do to help them.

“We can’t give them a narcotic to help them get off another. We just watch them (go through withdrawals) and keep them safe so they don’t hurt themselves or anyone else,” he stated. If an individual’s situation is bad enough, they can be sent to the emergency room, but that is on the taxpayers’ dime. “Our medical expenses are astronomical and we’re expected to be a triage, too, all on tight budgets. But mainly, we house them; we just wish we could do more.”

Opioids such as morphine, oxycodone, oxycontin, lortab and tylenol 3 have been the most commonly used prescriptions for acute and chronic pain in all age groups. Unfortunately, according to Whitney, “We have this very strong belief in our society that there’s better living through drugs.”

In spite of that, the current national trend, starting with the Centers for Disease Control and Prevention (CDC) and trickling down to Prairie du Chien’s own medical community, is to stop using pain as a “fifth vital sign,” or as an assessment tool alongside body temperature, pulse, respiration and blood pressure.

“We’re trying to change the tide on that to allow doctors to make more evidence-based decisions on who should be getting this medicine, and encourage changes to patients’ lifestyle habits that could help them work through the pain,” Whitney explained. “Part of [a doctor’s assessment] is looking at what risk factors [the patient has] for getting chronic pain and then why they’re not recovering on the road we’d like. One of the things we’re seeing, at the same time we’re seeing this drug use, is just a lot of sedentary lifestyles.”

People are a lot less physically engaged and more at risk for pain than they were 50 years ago. As Whitney described, a 5’8” man, back then, weighed 130-140 pounds and worked on a farm, so he had strong muscles to support his back and his joints. These days, that same 5’8” man weighs 200 pounds and works a desk job.

“There’s that belief that there’s a drug that’s going to fix me, when most studies show, for chronic pain, the most effective strategy is stretching, strengthening, moving strategy,” Whitney said.

People also tend to have more risk factors in today’s society, the doctor believes. Along with obesity often comes anxiety and depression, which factor into how people deal with their pain. People who abuse substances, like alcohol or other drugs, even caffeine, have a greater risk for experiencing problems with narcotics.

Also, he said, “just that whole concept of ‘somebody else has got to heal me instead of myself,’ really sets you at risk for problems with narcotics.”

Certainly, prescription painkillers provide relief, but they also start to trigger pain receptors, Whitney said, so the body needs more and more of that medicine to do the same work that maybe one dose did previously. That leads to other problems, which could include overdosing, impairment while driving or at work, etc.

Once the problem becomes an addiction, it becomes a real struggle to overcome it. While the cost of obtaining those drugs is expensive in itself, a five- to six-week inpatient rehab program is going to run around $20,000 and many of those programs aren’t covered by insurance.

That’s why the focus inside the medical field is on prevention—encouragement of activity and healthy eating. Whitney suggests hitting the gym, taking part in a water aerobics class that’s easy on the body, eating fruits and vegetables and really taking a look at personal pain management.

“Doctors in general are empathetic. They want to really believe their patients and help them work through pain to get better. But sometimes patients over-represent their pain because they have this desire to proceed in a certain direction,” Whitney shared. “Doctors, now, are trying to weed out who really needs this help or who’s trying to pull the wool over their eyes.”

He added that there’s a perception by patients that, if they have pain, the doctor should prescribe narcotics, otherwise he didn’t treat the pain and he was not a compassionate, empathetic doctor.

“Often, the opposite is true. The doctor spends a lot of time with you trying to explain your pain and better strategies to deal with it than giving you a drug,” he said.

In October, the Crossing Rivers Health ER employed its new evidence-based medicine strategy through which the goals are fewer prescriptions and more prevention motivation.

They’ve also made use of the Wisconsin enhanced Prescription Drug Monitoring Program (WI ePDMP) to combat ongoing prescription drug abuse. The program allows health care professionals, law enforcement, public health officials and pharmacies access to a central hub where records are saved for controlled substance prescriptions dispensed statewide. This provides professionals a look at who might be attempting to obtain prescriptions from multiple locations across the state.

“We get a lot of calls about stolen medicine,” Prairie du Chien Police Chief Chad Abram said. “But we don’t see as many reports of false scripts as we used to, with everything being done electronically now.”

Abram pointed out that the public is making good use of the prescription drug drop box that’s been available 24/7 inside the sheriff’s department for the past three years. Prescriptions of many kinds may be left there, where law enforcement collects them, secures them and delivers to the Drug Enforcement Administration twice a year.

Thanks to the ePDMP, from July through September 2016, in Wisconsin, there was a 9.63 percent reduction in prescriptions and a 9.89 percent reduction in drug doses as compared to the same period in 2015.

Since October, prescriptions written through the Crossing Rivers Health ER have also dropped, from 450 to 110. This movement has required a commitment by doctors to review a lot of charts and provide more education than simply prescribing an opioid as a solution, Whitney said.

It’s been a challenge but an important one that can save lives, “because one patient going down an inappropriate path,” according to Whitney “is one too many.”

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