According to a new report from the Centers for Disease Control (CDC), Franklin County ranks among the highest in the nation for opioids prescribed by physicians.
The report states the wide variation among counties suggests a lack of consistency among providers when prescribing opioids.
Dr. David Chalk, president of the Mercy Clinic, Four Rivers Division, says the turn to opioids for pain management began in the medical community 15 years ago.
“The Institute of Medicine came out with a proclamation that pain should be considered a fourth vital sign,” he said, “along with heart rate, blood pressure and breathing rate.”
Chalk added with the increased importance placed on pain, a new family of drugs were mandated for management — the opioids hydrocodone and oxycodone.
“Today we live in a society that there must be a pill to fix everything,” he said. “With more of these drugs out there, more people are looking for them.”
Types of Pain
Chalk explained opioids are prescribed for both acute and chronic pain, and the amount of pills prescribed is based on what a physician determines the patient will need for relief.
“With acute pain, someone breaks their arm or has surgery, patients usually take what they need and they are done,” he said. “Chronic pain contributes to the challenge. There aren’t enough pain management centers so the burden tends to fall on primary care physicians.”
Chalk said, despite successful treatment of an injury or illness, patient inconvenience is a top factor in doctors getting poor ratings and complaints. This has led to doctors writing prescriptions for larger amounts of pills each time.
“In the past, we could simply call in the prescriptions,” he said. “Now, we have to have a written prescription for refills and patients have to come back into the offices. So, we try to prescribe the amount we think they will need.”
The CDC reports even at low doses, taking an opioid for more than three months increases the risk of addiction by 15 times. It recommends for acute pain three days or less is often enough and more than a seven-day supply is rarely needed.
So, if opioids are so addictive and dangerous, why are they still being prescribed?
Chalk says there are really no better alternatives for treating pain without the side effects associated with other drugs.
“I don’t want to lay the blame on physicians, but the other alternatives are not as effective,” he said. “You can’t really paint it with a broad brush. These drugs work on the receptors in the brain and unfortunately, patients can develop physical and psychological addictions.”
To eliminate the addiction factor, the CDC recommends drugs like acetaminophen, ibuprofen and naproxen as alternatives to opioid prescriptions.
If opioids are needed, the CDC also recommends lower morphine milligram equivalents (MME) which measure the amount of the opioids in each dose.
In addition to patients becoming addicted to opioids and possibly moving on to illegal street drugs, Chalk said prescriptions falling into the wrong hands also has led to the epidemic.
“This is something we as county physicians, all of us need to deal with,” he said. “Grandma used one-third of her prescription and put the rest in the medicine cabinet. Then next thing you know her grandson is at a party with the rest of them.”
The CDC reports the amount of opioids prescribed per person was three times higher in 2015 than in 1999.
The total amount prescribed in 2015 alone was enough for every American to be medicated around the clock for three weeks.
Pill shopping, the practice of traveling from county to county to find doctors who will prescribe the drugs, also has become a trend with those seeking opioid prescriptions.
To remedy this, Chalk supports a statewide prescription drug monitoring program (PDMP) to track prescribed opioid users and potentially their efforts to acquire the drugs outside of their home areas.
“Franklin County has become a destination for people seeking narcotics,” he said. “Because Missouri is the only state without prescription monitoring, Franklin County is behind other counties.”
Chalk added Franklin County doctors are monitored by the state Bureau of Narcotics and Dangerous Drugs and the State Board of Healing Arts.
“Insurance plans also are monitoring patients getting prescriptions from multiple providers,” he said. “That seems to send up an initial red flag.”
Chalk said if flags are raised in the Mercy system, consultations are held with the patients to assess if treatments alternative to opioids are needed.
Statewide, there are 95 painkiller prescriptions per 100 people.