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Sunday Centerpiece

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      Editor’s note: Journal Gazette photographer Rachel Von lives and works in downtown Fort Wayne.
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    Minn Mying Nan Tin, director of the Burmese Advocacy Center in Fort Wayne, recently returned from her second trip this year to Myanmar, the homeland she left more than two decades ago.
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Alleviating pain in all its forms

Patients’ comfort balanced against potential harms

Here’s a startling fact: Indiana has the 17th highest drug overdose mortality rate in the United States, with 14.4 per 100,000 people suffering drug overdose fatalities. According to a new report, “Prescription Drug Abuse: Strategies to Stop the Epidemic,” the number of drug overdose deaths in Indiana quadrupled since 1999, when the rate was 3.2 per 100,000. Even more startling? A majority of these overdose fatalities are from prescription drugs.

Unfortunately, pain is an epidemic in our society that, for the appropriately screened and selected patients, requires medication for relief. From debilitating neck or back pain to failed back surgery to severe neuropathy, patients can present with a plethora of pain conditions. Imagine pain so excruciating that, without the proper treatment, the person is physically incapable of doing daily activities such as carrying groceries, driving a car, hiking or even walking to the kitchen. Some pain-sufferers can’t sleep or carry on relationships with others, which ultimately leads to depression.

Prior to using opioid-containing medications, a good pain management physician will use a more conservative approach such as physical therapy, interventional procedures and non-opioid medications. In many instances, a physician who is trained and board-certified in pain medicine can employ a combination of multi-modal approaches to relieve the pain and improve function. However, in some circumstances, opioid-containing medications are needed and can be very effective.

Federal health officials state that more than 115 million people in the United States suffer from pain, and some of them are our friends and neighbors in Indiana. These people are cancer patients, migraine sufferers, people recovering from invasive neck and back spine operations, and many others for whom pain is a daily occurrence. Without prescription painkillers, these people would have an extremely compromised quality of life – one that many of us who are well and pain-free are lucky enough not to suffer from.

So how do we ensure that people in chronic agony are able to receive the medications that allow them to go on with daily living, even living well, while also avoiding drug abuse and addiction that appears to be more and more a horrible side effect of the treatment package? How do we stay well, live well and stay safe from what has become an epidemic of drug abuse – threatening our neighbors, colleagues, teachers and, especially, our young people?

The solution is a strategic and comprehensive one. While there are many facets to ensuring care with safety, no individual or single entity can solve the problem alone. Our elected leaders, law enforcement officials, physicians, pharmacists and pharmaceutical companies need to work together in this process. I believe that one very important factor is the potential for more prevalent use of abuse-deterrent formulations of medications, coupled with comprehensive monitoring and strict enforcement.

Data show that 70 percent of medications that are abused are not actually prescribed to the individuals abusing them, or are taken in a way that is not intended. Those who abuse painkillers often crush the pills and then inject or inhale them. As part of a comprehensive solution, we need pharmaceutical companies to do their part in making it harder for people to misuse prescription opioid medications in these ways.

Fortunately, there are several companies that have begun to incorporate abuse-deterrent technology in their prescription pain medications.

The technologies work in several ways, sometimes making pills impossible to crush or changing them into a thick substance that cannot be injected if heated. The technology acts as a barrier to prevent misuse, while enabling patients to get the medications they need.

In order to make sure pain-killing drugs prescribed are in fact the drugs needed for each individual patient, the Food and Drug Administration issued guidelines calling for closer physician-patient consultations. The FDA has raised standards for physicians to follow, providing a subjective checklist to gauge patients’ pain. Physicians now must observe various important markers of the patient’s functionality. These standards are also a step in the right direction.

Indiana physicians have a choice when deciding what to prescribe a patient in need. With abuse-deterrent formulation opioids more available, I encourage all physicians to use them when they can so we can treat pain and continue saving lives.

Dr. Daniel Roth is board-certified in pain medicine and physical medicine and rehabilitation. He practices interventional pain management at Summit Pain Management in Fort Wayne. He is a member of the Indiana Attorney General’s Prescription Drug Abuse Prevention Task Force. He wrote this for Indiana newspapers.