Opinion: Dr. Jamie Teumer–Opioids: Talk Before You Take

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Photo by Alexa Mazzarello on Unsplash
Dr. Jamie Teumer, left, medical director for UCHealth Longs Peak Hospital Emergency Department. Photo by Kati Blocker, UCHealth.

A recent study of Coloradans found nearly 80% of have been prescribed an opioid at some point in their lives. This finding from the Colorado Consortium for Prescription Drug Abuse Prevention demonstrates there is a good possibility that you or a family member have been prescribed, or will be prescribed, an opioid prescription pain reliever such as Percocet, Vicodin, and Oxycontin.

Prescription opioids are effective for pain relief when used appropriately, however, opioids come with risks including serious interactions with other medication and addiction. Before I prescribe an opioid, I always have a conversation with my patient.

Since 2017, every UCHealth emergency room in Colorado has instituted guidelines to reduce the number of opioid prescriptions we write, and to reduce the number of pills in each prescription. Whenever possible, my colleagues and I use alternatives to opioids (ALTOs), which do not carry the same risk of addiction or overdose.

For example, lidocaine, typically used by dentists, can be administered intravenously to treat the pain associated with kidney stones. Nitrous Oxide (laughing gas) can now be provided in the ER. And Haldol, historically used for sedation, can also help with certain types of pain conditions associated with vomiting. Ibuprofen and physical therapy are also excellent alternatives.

Since the beginning of 2018, 121 health care professionals have participated in seminars by the Colorado Consortium for Prescription Drug Abuse Prevention which aim to increase use of alternative pain treatment.

Additionally, medical professionals are committed to using the Prescription Drug Monitoring Program (PDMP), a database that allows doctors to track all prescription drugs a patient is taking and to look for alarming patterns in prescription drug use that could signal abuse. The PDMP also provides doctors with a patient’s current medication list so they can avoid prescribing certain combinations of medications with dangerous, even lethal, interactions. One example is anti-anxiety medications, like Xanax, and opioids. Nationally, 77% of pharmaceutical overdoses involving anti-anxiety medication also involved a prescription opioid, according to the Journal of the American Medical Association.

Patients must also get invested in reversing the opioid epidemic. That starts with setting realistic expectations of pain. Each time I see a patient in pain, I ask two questions: What is your level of pain on a one to 10 scale?  And, what is an acceptable level of pain to leave with? If you’re experiencing pain at level 8, leaving with zero pain is not realistic. But we may be able to use ALTOs to safely bring your pain to a level 2 or 3 without using an opioid.

Next time you have an appointment with your doctor, dentist or pharmacist, have a conversation about the risks and alternatives to opioids. You can find questions you should ask under the “Opioids” tab at TakeMedsSeriously.org.

Dr. Jamie Teumer is a member of Emergency Physicians of the Rockies and cares for patients at UCHealth Longs Peak Hospital in Longmont and UCHealth Medical Center of the Rockies in Loveland.

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