More resources, support needed to address addiction and chronic pain

October 16, 2018

This vision of addiction and chronic pain care is a pipe dream in this era of such limited resources.

Editor’s Note: Physician Practice’s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or UBM.

Having worked for many years as a PA, my experience in emergency medicine, urgent care, and surgery has put me on the front lines of acute and chronic pain treatment. Like all providers, I struggle to balance adequate pain control against potential patient addiction to pain medications. I am reminded daily of the inadequate resources available to effectively treat pain and the potential side effects of opioids and other pain medications.

Every day over 60 Americans die from an opioid-related overdose. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014, nearly 2 million Americans were addicted to prescription painkillers and nearly 600,000 people were addicted to heroin. Unfortunately, treatment programs offering assistance with things like medication, proven to increase patient survival and program retention, have no where near enough capacity to treat all of these people suffering from substance abuse.

We who are on the front lines of patient care all too often deal with the problem of addicted patients or patients in chronic pain by referring them to pain management specialists. These patients consume an inordinate amount of time-time that harried providers don’t have. Chronic pain and addiction are just two of many problems these patients suffer from. The only effective solution is one that is comprehensive and addresses a patient’s physical, psychological, and emotional problems in an all-encompassing approach. This vision of addiction and chronic pain care is a pipe dream in this era of such limited resources. Time is not the only limiting factor. The lack of medical treatment for addiction, outpatient treatment programs, and providers who can prescribe addiction medication are all limited. 

Federal, state, and local government agencies must work together to provide the multi-disciplinary resources needed to effectively support physicians, PAs, and other providers in better treating addiction and chronic pain, or real progress will not be made. 

I realize that PAs represent just one piece of a very complex puzzle, but effective deployment of PAs can help to address the addiction and chronic pain problem by taking these national, state, and local policy steps:

1. Continue to streamline legislation that allows PAs and other providers to prescribe buprenorphine for the treatment of opioid addiction. Legislation signed by President Obama in 2016 enabled PAs and NPs-after completing appropriate training-to apply for waivers to prescribe buprenorphine until 2021. Two years later, after a lot of legislative wrangling, Congress is poised to pass a bill that will make the waiver provision permanent. Removing the 2021 end date will eliminate one barrier to the critical shortage of healthcare providers who are willing and able to provide medication-assisted treatment for patients with opioid use disorder. But it would have been a lot simpler and efficient if the original law had done that.

2. Support legislation that increases access to treatment for opioid addiction and strengthen provider training in the areas of pain management, safe prescribing practices, and treatment of patients who are struggling with drug addiction.

PAs are committed to serving our patients, who give purpose to our lives. Like all providers, we do best when we can make a meaningful difference. We need more research, better medications, expansion of treatment programs, and access to tools that can effectively address the problem of chronic pain and addiction. From a societal standpoint, if we are not part of a comprehensive solution, we are a part of an intractable problem.