News from Maine- On prescribing pain medications

Comments anyone?

BANGOR — The art and science of managing pain has challenged practitioners of both traditional and alternative medicine for centuries.
In Maine, the widespread abuse of opiate-based drugs used to treat pain has complicated health care providers’ efforts. It’s a problem that has evolved into a public health and public safety issue.

Part of the challenge is that providers must rely on patients to explain their symptoms.

“Pain is a totally subjective experience,” said Dr. Ben Zolper, who heads a team of pain specialists at his Northeast Pain Management practice in Bangor. “It’s not a measurable event, not something you can put a number to. If someone says ‘I have a broken leg,’ an X-ray can confirm that. But when patients come in and say ‘I have pain,’ they are the only ones who can confirm that.”

Maine Public Safety Commissioner John Morris attributes a 5.4 percent increase in crime in Maine between 2010 and 2011 to addicts committing crimes to feed their cravings for illegal and prescription drugs.

Zolper and his colleagues have built their practice on the premise that pain is not a diagnosis, but rather a symptom of some underlying medical problem.

“We have an anti-pain pill philosophy that reflects standard medical practice,” he said. “We do a history, a physical, imaging and then an examination of treatment options. The goal is to devise a treatment strategy that allows us to cure or moderate the problem so the patients don’t need pills and can still have reasonable function in their lives. Our solutions often involve exercise, physical therapy and the use of other classes of drugs.”

While Zolper’s pain management team of four physicians and four nurse practitioners seldom prescribes opioids in managing pain, Dr. James Whalen, an orthopaedic specialist now in his 33rd year of solo practice in Machias, has never prescribed opioids, and never will. Whalen would like to see a statewide ban on prescriptions for methadone, suboxone and OxyContin.

“There are two universal facts about addiction,” Whalen said. “The first is its habit of use often outlives the initiating reason for use. The other is that people with addiction issues are invariably intelligent and skillful at persuasion. … Addicts know how to exploit physicians and providers to achieve their pills.”

Like Zoper, Whalen sees pain as an indicator of some other problem.

“It tells me there is some underlying issue that you have to figure out,” Whalen said. “And, as a physician, you are supposed to have the intellectual capacity to figure it out.”

Zolper said his patient base includes people with pain who either don’t want any part of opioids and their addictive side effects, or have been on opioids and are eager to be weaned off their dependence on them.

“In my experience, the average person does not want to be on pain pills,” Zolper said.
Source:
Sun Journal

Where does suboxone fit in the state wide ban??? I'm not quite sure that I understand the purpose of banning it or any other drug. It's not like you can't go to another state. We don't need more criminalization for patients. We need more education in the medical field. Even with my limited knowledge, I know that pain does indeed have physical indicators, like a rise in blood pressure and pulse and respiration rates. Unlike lying these changes can be measured over time and differientiated. Granted pain is a totally subjective experience, but it does cause measured physiological changes. I saw a study recently that showed MRI being used to diagnose the exact place in the brain pain was being experienced. And in people who aren't opiate dependent it also causes changes in the activity in the centers of the brain that cause dopamine and endorphin release. If I as an addict, whose profession is accounting for the record, can learn that much about the physiological indicators of pain. What could a physician learn?? The simple fact is that they don't want to deal with the problem so it's easier just to criminalize the drugs and let the judicial system deal with the fallout. Even if they did get rid of opiates for pain control, suboxone isn't designed to be used for pain control. Pharmacologically it is different from methadone and most other opiates in that it has a ceiling effect because it is a partial agonist, thereby not producing the pain relief or euphoric high that is a side effect from full agonist opiates. I am fully aware that some physicians use sub for pain, but I honestly think that is more to satisfy the patient psychologically than legitimate relief. Opiates have their place in medicine, whether I can personally benefit from them or not. And suboxone certainly does not deserve to be lumped in with the rest. The fact that sub is the only drug approved by the fda for outpatient maintenance treatment from a regular physician is a testament to how much safer it actually is than methadone. This is just more rediculous retoric to satisfy people who don't know their head from their ass when it comes to what causes the problem of addiction and know even less about how to handle it. While I do think that their should without a doubt be tighter controls and more monitoring on physicians dispensing addictive meds of all types banning the medication won't end the problem, it will only send people looking elsewhere, drive prices up, and probably ultimately lead to more crime.

I was pretty surprised to see Suboxone in that list of drugs Dr Whalen wanted banned.
I can respect their decision not to prescribe opiates for treating their pain patients and trying other means of treatment. I always thought half the patients in my pain management office were only there for one reason. To get drugs. That was my reason half the time.
But why mention Suboxone.
They obviously realize there is an addiction problem.
Why not use the means to treat it ?

There is no reason what so ever to lump Suboxone into this equation. Something that I read this past week had me to a double take as well. I am being place on medicare effective August 1st. I was looking through the drug formulary to see if Suboxone was an approved medication or if I had to have a prior authorization. Much to my surprise, Suboxone is listed as a non-narcotic pain reliever.

While I do think opiates are prescribed too often, I also think they do have a place as their are some legitimate people who do require pain medication. Each case should be seen on a case by case basis.
I don't think banning medications period is the way to go. I can't ever imagine being a patient of this Dr. Walen

Blue Eyes your question about treating addiction with Suboxone, that probably falls in to the category of if they try hard enough they can stop using. Just my two cents

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