By Susan Baumgaertel, MD/The Polyclinic
Here’s the thing: the Opioid Crisis is real. It is so real, it tarnishes every day in medical practice. The lives lost, the inappropriate drugs prescribed, the fierce posturing on all sides to “make it right” again. How sad this is even happening.
Yet, despite governmental regulations popping up everywhere, this is a time for education and learning. A time for restructuring and hope. Truly.
Every work day now starts with logging into our state’s Department of Health Prescription Monitoring Program database to look up the daily roster of patients and to see what controlled drugs they are on. The search is drilled down to when they got their prescriptions filled, how many pills were dispensed, at what pharmacy, and prescribed by which physician. There is even a button to click to see a map of all the pharmacies they have visited to get their prescriptions filled.
By logging into this vast database an electronic trail is created to prove that the information search has been undertaken…a “query” has been made…and then this is documented in the patient’s medical record at the time of their appointment. Even more helpful is the feature of creating a PDF to print, thus showing the patient on paper exactly what is being tracked.
Knowledge is power, and the visual display of prescription records over the past year or more is very compelling. This provides clarity and transparency in the typically difficult discussion about controlled medication management. It is amazing to me how easily patients stop taking their blood pressure or cholesterol medications, but are fierce to defend even a small tapering of their opiate Rx, not to mention even stopping it entirely. But that is the power of addiction (or dependency, to be more polite).
And it’s not just opiates under the magnifying glass. Opiates, benzodiazepines (think Valium and Xanax), sleeping pills (like Ambien), ADD meds and even Tramadol – all these medications are now under closer scrutiny and on the list of prescriptions to monitor.
So, it was with great trepidation that I started this new journey at the beginning of the calendar year. I anticipated arguments and heated discussions, and fully expected that some patients might even decide to go elsewhere for their care. Much to my surprise, it has been the opposite experience. I have lost track of how many discussions have started with “we need to talk about your ___ (fill in with controlled drug name) use and see if we can start to taper it or even stop it.” What ensued were healthy discussions of how to combat pain, anxiety, panic disorder, insomnia and many other conditions without the use of medications (or, at least, a controlled one).
These discussions take time. They also take respect and kindness. They couldn’t come about without trust and mutual respect, which is the cornerstone of any meaningful doctor-patient relationship. No “line in the sand” is drawn, no ultimatum is given. Just a simple, open and honest discussion of what is safe and what is the best path to take for one’s health. I have a huge list of alternatives at my disposal, which makes it all that much easier to end up with a win-win. There are plenty of safer medications to take for the ailments listed above. There is also acupuncture, cognitive behavioral therapy, tai chi & qi gong, mindfulness meditation, and so many other avenues to explore. I even offer a bimonthly stress management workshop which is getting more popular by the day.
The “proud mother” moments for me come one month later, when patients report back on how they are doing with initial changes in their medication regimen. Often they are feeling better with less pain and less anxiety (go figure!), or at least acknowledge that things are stable and not worse. The next steps are taken and it becomes clear that there can be a life without these medications. Hope.
Instead of feeling drained and frustrated, I am invigorated by this daily routine. I look forward to these appointments and see them as opportunities for improved health and wellness. The “refill request” appointments listed on my daily schedule used to be angst-provoking, but now I eagerly await the individual discussions that may set the stage for each patient to transform their health.
Susan J. Baumgaertel, MD is a longtime member of the King County Medical Society. She practices internal medicine at the Polyclinic, helps lead the unique Partnership in Health collaborative, and is the medical director of Menu for Change program, an innovative weight management wellness program.