As the national opioid epidemic continues, representatives from the medical, treatment, and insurance fields met in Bloomington at a roundtable discussion to talk about more collaboration to care for addicts and prevent addiction.
Twenty-four people have died from opioids in McLean County so far this year, most by accidental overdose. That’s according to Chestnut Health Systems CEO Dave Sharar.
This year, Chestnut admitted 800 adults and adolescents for opioid use. Nearly 20 percent identified prescription opioids as their primary drug of choice. The remaining 80 percent named heroin.
Sharar said many heroin users start out using prescription medication, but migrate to heroin after the prescription runs out.
“I was part of the problem, and I am now trying to be part of the solution, in terms of this opioid crisis that we face in the country today,” said Dr. John Wieland, general surgeon with Integrated Surgical Specialists.
A 2016 Health and Human Services statistic shows that 11.5 million people misuse or abuse prescription opioids, causing an average of 116 deaths a day nationwide.
“We are obviously in a crisis. It’s been called an epidemic, and I think that’s probably legitimate,” Wieland said at the Nov. 28 event.
He said the drug industry is to blame for aggressive marketing of synthetic opioids. But he said opioid-prescribing doctors also hold some responsibility for the epidemic.
“We started out with noble intentions,” he said. “We wanted to cure pain instead of manage pain.”
"We started out with noble intentions. We wanted to cure pain instead of manage pain."
Wieland said that early research showed cheaply made synthetic narcotics were less addictive. But, data in the late 20th century misjudged the implications of over prescribing opioids.
“At the time, they called pain the fifth vital sign, even though many physicians disputed this, it became a metric by which some physicians were actually judged and performance measured,” he said. “And still today, we’re trying to extricate ourselves from that.”
Included in that, Wieland said, is changing how physicians use patient satisfaction surveys.
So, what are doctors doing to combat the already rampant opioid crisis? Wieland said the No. 1 goal is obvious. Prescribe fewer opioids.
Illinois passed a law in 2014 requiring hand written and signed opioid prescription orders.
He said this law created a barrier to access that proved helpful. It was no longer as simple as calling the doctor and asking them to put in a refill.
The law also led to more prescription monitoring programs, Wieland said, which drew attention to polypharmacy problems, or patients who utilized multiple opioid prescribers without providers knowing.
Now, Wieland said doctors are better at acknowledging that pain is subjective. People rate it differently, he said, which means prescribing pain medicine is not one size fits all.
“Pain is not a vital sign. It cannot be objectively measured. So therefore, each patient has to be treated on their own level,” he said.
He said doctors are going back to prescribing pre-narcotic medicines for pain, like acetaminophen and nonsteroidal anti-inflammatory drugs. Or in some cases, Wieland said, not using drug treatment at all and prescribing massages, acupuncture, biofeedback, or even yoga.
Illinois Department of Insurance Regional Outreach Coordinator Carol West said a major change in opioid treatment coverage promotes those alternative treatment methods. In 2020, Illinois will be the only state in the nation to change its benchmark plan.
West said a benchmark plan is what all other insurance plans are based off in the state, including the base benefits package.
She said the change will mandate coverage for alternative pain therapies like those mentioned by Wieland.
“The limit on opioid prescriptions for acute pain mostly talks to the opioid naïve,” West said.
So those experiencing pain somewhere between three to six months.
She said this change requires the insurance agency to give anyone prescribed 50mg or higher of an opioid at least one reversal agent nasal spray to prevent overdoses.
Since starting medical practice in the early 1990s, Wieland said he has cut his opioid prescriptions by about 75 percent.
“Which is not a boast. It’s almost a little embarrassing to admit that. To realize. Because that means I was overly prescribing that amount for patients,” Wieland said.
He said the average number of pain pills that one of his postoperative patients use is 10. But, his routine prescription used to be around 30 pills.
Now, Wieland said it’s doctors’ collective role to educate patients on the risks of dependency when prescribing opioids.
“Most patients that have routine surgery don’t have a goal of becoming an opioid addict,” Wieland said.
He said doctors need to be aware of that, and treat addictive behavior as the symptom it is, and not just shun those who are opioid-dependent.
Even with doctors like Wieland prescribing fewer opioids, some still become addicted and seek help at treatment centers like Chestnut Health Systems.
Brian Hinman, the court treatment coordinator at Chestnut, said there are negative perceptions of addiction treatment that are simply not true.
Hinman said caregivers treat people with compassion, rather than falling viewing treatment facilities like prison. Clients are not in lock down and have varying degrees of freedom.
He said a residential crisis detox, for example, lasts five to seven days. That allows clients to get opioids out of their systems and introduce them to mental health support services.
“Treatment is collaborative,” Hinman said. “It starts with the client. What their needs are, what they think is important, and create some structure there. And it’s not so much authoritative as more collaborative.”
Hinman said creating structure in the former addict’s life is not always easy, but can set patients up for a productive life outside of the facility.
Chestnut started in the early 1970s as an alternative to jail for individuals with public intoxication. It has since expanded to multiple service lines, with an estimated 700 employees throughout McLean County and southwest Illinois.
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