Q&A: Life After Opiates

With the new opiate prescribing laws fully in effect, providers must change their patients’ opioid doses or switch them to non-addictive medicines. Daniel Passerman, D.O., Henry Ford’s Associate CMO, Primary Care and Interim Chair of the Department of Family Medicine, addresses a few of the most pressing questions regarding this issue.

Q. What was the physicians’ role in the opioid epidemic?

A. When I started medical school some 20 years ago, they talked about pain being the 5th vital sign. It was engrained in us that we must take care of people’s pain. In the end, we have found that doing all we can to address a patient’s pain probably did more harm than good. The overprescribing of opioids is a self-made mess. We have people who have significant pain issues and have become dependent. The medications alter the receptors in the brain. They make the person more intolerable to routine pain. This means they don’t cope as well with normal pain, like stubbing their toe or twisting their ankle. In addition, they begin to build a tolerance to the medication. In short, we have overtreated their pain and caused more harm than good.

Q. What does this mean to patients now?

A. The expectation has been that we, as doctors, can control any pain. The reality is that sometimes we can’t safely control the pain.

Q. How is this shift going to happen?

A. Through communication and education. We’ve done it before, for instance with antibiotics. Patients don’t come in now expecting antibiotics for a viral infection; they know they don’t work for that. Something like this takes time. Most physicians know that we need to greatly reduce the amount of opiates we are prescribing. But it’s hard when the patient is sitting in front of you asking for help with their pain. Are the opioids allowing them to function? Can they live independently because the medication is allowing them to walk, go grocery shopping and not hurt?

Q. Where do patients go for help?

A. We need to let them know to contact their primary care doctor if they need assistance. We want to help everyone get through this and move on to a healthier place.
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