Does an 85-year-old female need the same dosage & quantity of opiates as a 35-year-old male? Does a ligament sprain require the same as a broken hip? Do any other factors play a role such as stress, smoking, or sleep? Does time of day matter in regards to a patient’s pain level?
America makes up about 5% of the world’s population but consumes over 95% of the world’s hydrocodone. This “investment” in opiates has not translated into better pain control, increased functionality and decreased disability either. In fact, we have observed quite the contrary.
What Must Prescribing Change?
We must demolish the way opiates are prescribed. The imprecision in the way opiates are currently prescribed has had fatal consequences, both to our patients as well as to our health care system.
In fact, the Center for Disease Control and Prevention have declared overdoses from opioid painkillers to be a public health epidemic.
Opiates are a class of drugs that include both illicit (heroin) and licit prescription pain relievers such as hydrocodone, oxycodone, fentanyl, morphine, and others. Although Opiates are dangerous and their prescription must be individualized for specific patient needs.
Substance abuse, addiction, street sales and overdose death are being facilitated by the imprecise, over-prescription of opioids and this issue is not simply just “the doctor’s fault.” It is much more complex than that.
The Pain Process
Physicians have a very challenging time prescribing opioids. Pain is now considered the “fifth vital sign.” While the other four measures are objective (heart rate, blood pressure, oxygen saturation and respiratory rate), pain is currently not.
Pain is a subjective measure that has now been placed into an objective category. This is extremely dangerous.
In addition, hospitals and physicians are beginning to have their reimbursements tied to patient satisfaction with their pain or lack thereof. This relationship has not only led to over-prescription of opiates, but also the dangerous leverage for patients to demand more opiates.
To make matters worse, the current prescription of opiates are schedule 2, which requires physicians to regularly prescribe a larger quantity of narcotics than necessary to patients to prevent patients from potentially running out of pain medicine before their next follow-up visit.
What Is To Be Done?
As a medical consultant to VEEP Works technology, we are collaborating on creating the intelligence and real-time technology to empower physicians with extremely valuable data evaluating a patient’s subjective, objective, and biochemical markers to individualize a patient’s need for opiates. With this information, only the exact quantity of pills at the exact dosage will need to be prescribed, leaving fewer pills in the bottle to become addicted to, sell on the street, or accidentally overdose on.
This will make this world more intelligent, precise, and safe for our patients.
Dr. Amit Mirchandani is a Texas Pain Management Specialist and double Board Certified by the American Board of Anesthesiology and the American Board of Anesthesiology – Pain Management. Dr. Mirchandani joined Metropolitan Anesthesia Consultants in 2011 and specializes in Orthopedic based Anesthesia as well as Regenerative Medicine, i.e. Stem Cell Replacement Therapy. Dr. Mirchandani has been named 2016, 2017 Top10MD an honor only 1-in- 3 doctor’s in the United States succeed with this recognition. To schedule your appointment contact Dr. Mirchandani at 972-668- 9612.