The patient-doctor relationship: Eroded by the opioid epidemic but essential to overcoming it

By | December 18, 2018

The opioid epidemic has swept through communities across the country, and according to the National Institute on Drug Abuse more than 115 people in the U.S. die every day after overdosing on opioids. This crisis is dominating the headlines as physicians, hospitals, community groups, elected officials, businesses and families try to tackle this massive problem. Opioid addiction is a complicated issue, and it will take more than a silver bullet solution or public health emergency declaration to get it under control. There is rightfully a lot of anger, frustration, sadness, and certainly criticism being levied at different parties.

As this problem has become more prevalent, I’ve been increasingly concerned to see how the opioid epidemic has undermined and eroded patient-doctor communication and relationships. Patients and doctors are, and must remain, on the same team in identifying health problems and appropriate treatment plans. A breakdown in trust and communication makes it much harder to effectively deal with tough pain management issues and restore a patient to fuller health and wellness.

At times there is mistrust about a physician’s motivations; some news coverage has essentially suggested that pain physicians may be using the opioid epidemic as an excuse to perform costly interventional procedures to line their pockets instead of just prescribing pills. That couldn’t be further from the truth. I’ve seen arguments in the clinic where a patient accuses their doctor of unnecessarily denying them needed medication – complaining that they feel unheard and their pain is not being taken seriously. On the other hand, I’ve also heard physician colleagues discuss amongst themselves their well-founded caution against prescribing opioids and concerns about accusations against “over-prescribing doctors.” They need to asses a patient’s health and pain symptoms carefully, while also trying to determine whether addiction is an issue.

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While no physician wants to prescribe a drug that is misused by a patient, doctors must still be able to prescribe opioids when they are needed without fear of losing their license or going to jail.  They should issue those prescriptions judiciously, responsibly and within guidelines, using compliance tools like state drug monitoring databases.  It is also incumbent upon physicians to ensure their patient feels heard, informed and empowered in the treatment process and knows they are on the same team as their physician.

When opioids are not appropriate, or a doctor is unsure of the best treatment option – it’s best to seek consultation from a pain management expert. Physician anesthesiologists who specialize in pain medicine have received additional training in a wide range of pain management techniques. We can identify the best pain management treatment for each individual, which often includes using non-opioid approaches.

Patients need to understand that opioids are high risk and should only be used for short-term, high-intensity pain problems – not for chronic pain.  Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and about five percent of those who misuse prescription opioids transition to heroin. Where possible, non-opioid pain management techniques and interventions should be considered. When opioids are necessary, patients and physicians should have an open conversation about the importance of careful compliance with prescribing instructions.

No one starts out hoping to become an addict. Many are seeking help to treat legitimate pain, and then become victim to opioid abuse. The healthcare community as a whole must modernize our approach to pain management and treatment – which includes utilizing alternate treatment methods, as well as educating patients about why it’s ok to experience some pain sometimes that doesn’t need to be treated. This broader view of pain management is in line with priorities outlined by the U.S. Department of Health and Human Services and the Centers for Disease Control to address the opioid epidemic, which include focusing on prevention and advancing alternative practices for pain management.

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The key is for patients and doctors to come together and honestly discuss the patient’s health issues and treatment options. To do this, there must be trust and communication between the two individuals – not a divide that casts doubt on the motivations of each other.

Shalini Shah is an anesthesiologist.

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