Topic Thread

Topic: Opioids

1.  Opioids

Posted 04-17-2017 19:33
Just curious.  Since finishing my surgical training in the early 90's I've routinely written a script for 30 opioid pain pills after outpatient procedures.  Only recently have I cut this down to 6-10 tabs for most procedures, and I find on follow-up that most of my patients use only a couple (I counsel them to discard of the remainder.)  Anybody else finding that changing their prescribing patterns has been this "pain-less"?  The implications are quite obvious with our current glut of pain pills and the recent data showing that 6% of opioid-naïve surgical patients become chronic users.
Tom

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Thomas Veverka MD
Medical Director of Trauma
Mid Michigan Medical Center-Midland
Midland MI
989-839-1795
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2.  RE: Opioids

Posted 04-18-2017 10:31
Hi Tom,

I agree completely with your observations. At one of our local hospitals in Flint we are disseminating data regarding how much pain medication patients use after common procedures.

U of M has been helpful in sharing their data. This link stated exactly eat you have observed

https://medicine.umich.edu/dept/surgery/news/archive/201611/surgery-faculty-launch-plan-reduce-opioid-prescribing

The less extra narcotic medication sitting in people's homes, the better.


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Bobby Mukkamala
Otolaryngologist
Flint
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3.  RE: Opioids

Posted 04-19-2017 16:14
Sorry for typo.

"Exactly what you have observed"

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Bobby Mukkamala
Otolaryngologist
Flint
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4.  RE: Opioids

Posted 04-20-2017 11:10
More than 90% of abused opioids are prescribed by one of our brother or sister providers. Many then are diverted surpluses of prescriptions that are shared with friends and family for various pains. "These are the best pain pills, I have tried." Family members access supplies without permission also. We are the gateway to addiction. Many providers do not seem to share our avowed longing for chitchat with patients. Give a generous supply of opioids and avoid off hours phone calls and complaints after procedures. We are the epidemic. Albert Dugan, MD





5.  RE: Opioids

Posted 04-22-2017 17:28
  |   view attached
Although there is enough blame to go around...patient expectations, Joint Commission pain scores, CMS patient satisfaction, and pharmaceutical industry pill pushing, today's physicians and their prescribing habits & treatment plans are huge contributors to what everyone recognizes is a serious and growing problem.  As physicians, we have the influence and opportunity to take control of a public health problem where we have both willingly and unwillingly acted as facilitators.

Last year I attended a presentation while in attendance at a meeting of the MSMS Committee on Legislation and Regulation.  The discussion was led by local law enforcement, Michigan AG's office, and Federal officials from drug enforcement and U.S. AG's office.  It was a very enlightening presentation.  I included the slide deck as an attachment for you to draw your own conclusions...




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Kenneth Elmassian D.O.
Past President, Michigan State Medical Society
Past President, Michigan Society of Anesthesiologists
Capital Area Anesthesiologists, PC
Lansing MI
517-974-2377
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Attachment(s)

pdf
Drug Diversion (MSMS).pdf   3.09MB 1 version


6.  RE: Opioids

Posted 04-23-2017 18:57
Dr. Ken Elmassian,

Thank you for your thoughtful response (and power point) to the difficult issue of deaths via prescription drugs.  This is a complex issue needing a response on many societal levels. Placing blame in a simplistic manner, appears to me to be counterproductive.

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Kenneth Fisher MD
Physician
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7.  RE: Opioids

Posted 04-30-2017 19:40
Ken, once again you have brought clarity to  very muddy complex problem. I have presented to Julie Novak rough ideas for MSMS to be the leaders in providing a multi-faceted seminar that could be viewed live on the web. The seminar would include elements of the one you attended

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Mark Komorowski MD
Bay City MI
989-893-9393
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8.  RE: Opioids

Posted 05-01-2017 09:09
Dr. Komorowski,

The unintended consequences of patient satisfaction surveys, needs to be addressed.  http://www.cbsnews.com/news/opioid-epidemic-doctors-say-hospital-patient-satisfaction-survey-fuel-dependence/  Value is an individual judgement that CANNOT be measured by 3rd parties.  We need a patient-focused and directed system! 

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





9.  RE: Opioids

Posted 05-02-2017 14:23
Dear Dr. Fischer, 
Patient guided activity, decision-making  is laudable. But given power relationships vastly over- weighted in the direction of the physician, we just need physician prescribing brought back under control. We are in a tsunami of prescription opioid abuse that we are driving with our behaviors. Other factors are contributing surely, but our part can be addressed. There is enough resistance to restraint in the professions to expect government will need to step in. Voluntary efforts do not reach the careless ones and the rogues in our family who shrug off any sense that they need to change practice habits. Albert Dugan, MD





10.  RE: Opioids

Posted 05-03-2017 19:33
Dr. Dugan,

I agree that physicians have a role to play in preventing this drug overdose problem.  But, so do many others.  Patient satisfaction scores are a large contributory component.  We are a drug obsessed society fostered in part by commercials on T.V., we have the Clinton administration to thank for this.  We have pleasure seeking by many, not seen a generation ago.  You may have noticed that pain is considered by some an additional vital sign.  Hospitals to improve their satisfaction scores are insisting that patients leave the E.R. with a plethora of drugs to address pain.  
This has become a cultural problem that needs addressing on many fronts not just with physicians.  

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





11.  RE: Opioids

Posted 05-05-2017 04:15

Why do you have to  throw stink bombs in the middle of this debate on the opioid epidemic? Blaming Clinton is about as logical as blaming Barbara Bush for George W.

 

Herman C. Sullivan MD

Medical Director, MS Clinic

Hauenstein Neuroscience Center

220 Cherry St. SE

Grand Rapids MI   49503

Clinic:  616-685-4170

Front office: 616-685-5050

 


Confidentiality Notice:
This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential.  Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email.





12.  RE: Opioids

Posted 05-06-2017 08:51
Dr. Fisher's absurd statement, "Hospitals to improve their satisfaction scores are insisting that patients leave the E.R. with a plethora of drugs to address pain" is absolutely false. Fake news!!

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James Mitchiner MD, MPH
Ann Arbor MI
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13.  RE: Opioids

Posted 05-07-2017 17:53
Dr. Mitchiner,

Thank you for your interest in my comment.  May I refer this article to you.  http://www.modernhealthcare.com/article/20150604/NEWS/150609953 

In my own experience and that of many family members, friends and others who have been discharged from hospitals and E.D.'s having either refused or questioned being prescribed a hefty supply of pain meds.  Why is this taking place?  I suggest in some or perhaps large part it is because of the finances due to patient-satisfaction scores, note the above article.   

Do I believe that patient satisfaction scores are the only factor, NO!

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





14.  RE: Opioids

Posted 05-07-2017 17:53
Dr. Mitchiner,

I thought you might enjoy reading this article from CBS News, "Are patient satisfaction surveys fueling America's opioid epidemic?

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





15.  RE: Opioids

Posted 05-07-2017 17:53
Maybe not at St. Joseph, but some local hospitals in my area,Novi, fill prescriptions un-requested upon discharge as a “convenience” (at least for the economics of the hospital pharmacy). It has happened to me!




16.  RE: Opioids

Posted 05-06-2017 15:47
Might the opioid epidemic be merely a sign of a much deeper ailment in our society? Why for instance, as reported, do 25% of women in America take a psychotropic drug of one sort or another.(cannot give a specific reference, but this percentage has been offered in a number of publications). In listening to a few of those who have been successful in escaping the clutches of addiction, there seems to exist a common thread: I took drugs to relieve the pain of being unhappy in my own skin. Why should this so often be the case?

I grew up in the 50s, and although probably not everyone I knew could be described as 'happy', most seemed to be content with their role in society as it existed. A sense of optimism prevailed. The use of drugs in my city of 50,000 was infrequent, and was largely limited to episodic alcoholic inebriation among people my age. I never knew anyone who used marijuana until attending university in the 60s. We have today become a 'chemical society', where the promise of a drug for almost everything masks the fact that they seldom cure any chronic disease, nor improve our lot in life, and are frequently associated with unpleasant, and sometimes dangerous, side effects including addiction.

Far fewer today are optimistic about the future. While in practice, I attempted as much as time would allow to follow the advice of the late, great clinician, Sir William Osler: "Listen to your patient, and he will tell you his diagnosis"; also, "a good physician treats the disease, whereas a great physician treats the patient with the disease". Although I certainly used my prescription pad, I never found it more effective in establishing the trust embodied in a sound doctor-patient relationship than listening carefully, and observing, my patients. However, I realize that the opportunity to exercise this most satisfying aspect of medical practice is being curtailed, and this is very sad for both patients and their physicians. Gary Gillespie, M.D.: Retired Family Physician









17.  RE: Opioids

Posted 05-07-2017 17:53
Dr.Sullivan,

Thanks for your interest.  You may recall that there was a time when drug companies did NOT advertise on T.V.  Much of this was voluntary.  However, it was during the Clinton administration when this practice ended under the concept that a better-informed public would benefit from T.V. advertising.  In my opinion, the public is NOT better informed, but more involved with the concept of the benefits of prescription drugs.  You may or may not agree with this, but I suggest not immediately discounting it as a contributory factor in this unfortunate opioid situation. 

Now that drug advertising is on T.V. I doubt, because of freedom of speech issues that it can now be reversed.

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





18.  RE: Opioids

Posted 05-08-2017 09:52

Dr. Fisher,

 

I do not disagree and am completely simpatico with your point of view. Little is gained in the public interest for Pharma's unabated appetite for selling drugs at any cost. And another important plank is Pharma's monetary influence within the FDA:  PDUFA, which  is the opiate of the FDA. As you know, PDUFA comes under congressional, not executive scrutiny.  Best regards,

 

 

Herman C. Sullivan MD

Medical Director, MS Clinic

Hauenstein Neuroscience Center

220 Cherry St. SE

Grand Rapids MI   49503

Clinic:  616-685-4170

Front office: 616-685-5050

 


Confidentiality Notice:
This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential.  Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email.





19.  RE: Opioids

Posted 05-09-2017 18:48
Dr. Herman Sullivan,

Thank you for your input on this difficult issue.  Drug advertising has, in my opinion, caused much unforeseen negative consequences.  Now that the genie is out of the bottle, I am afraid it will be extremely difficult to put it back in.

Best Regards,

Ken

 
Kenneth A. Fisher, M.D.
Tweet@kennethafisher
Co-Founder, Michigan Chapter, Free Market Medicine Assoc.
Author, "Understanding Healthcare: A Historical Perspective"
 
 
 





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