Doctor takes you inside ER to show how opioid crisis has changed his job

Medical professionals explain how approach to pain has shifted

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DETROIT - The opioid crisis had reached into the lives of countless families, but it has also had a significant effect on doctors as they change their approach to treating pain.

Dr. Frank McGeorge has a unique perspective as a practicing emergency doctor and medical reporter in Detroit.

"From the time I started practicing medicine to now, I've seen narcotic problems evolve from heroin, which remains a problem, to prescription narcotics, and frankly, that evolution was created by the medical establishment -- from drug companies to some well-meaning and other unscrupulous doctors," McGeorge said. "But now, we need to be part of the solution."

Pain, for one reason or another, is the No. 1 reason people see doctors, which makes doctor's offices and emergency rooms ground zero in reversing this deadly opioid epidemic.

McGeorge said the changes doctors have already made will affect virtually every patient seen.

Dr. Angela Pugliese, McGeorge's colleague at Henry Ford Hospital in Detroit, said the opioid epidemic has changed how she practices medicine.

McGeorge asked, "What are some of the issues that you've even faced in one shift today?"

Pugliese answered, "Three different patients with chronic back pain being managed by three outside doctors that I then have to determine a different plan of treatment."

McGeorge said these cases are difficult, because doctors don't want to leave patients in pain, but they have to recognize the potential for abuse and addiction -- and it's not a rare occurrence.

"It's an open and honest conversation," said Dr. Giuseppe Perrotta, another colleague of McGeorge's. "Sometimes it doesn't end well. Most of the time, they tend to understand and, you know, I've done everything I can to help them."

McGeorge said if the pain is from an urgent threat, it needs to be addressed, but patients and doctors need to change their mindset about pain.

"But one thing we have to be humble about, I think, is that I tell patients, 'We cannot eliminate pain to 100 percent. That's just part of the human condition,'" said Dr. David Kim, a pain management specialist at Henry Ford Hospital.

Rise of powerful prescription narcotics

Kim remembers the rise of powerful prescription narcotics including Vicodin, Lortab, Percocet and OxyContin. These quickly became the go-to drugs to control pain. Kim believes it's important to understand how the situation grew out of control.

"Taking it back to the '80s and '90s, it was a perfect storm where everybody was guilty," Kim said. "Everybody had their hand in the cookie jar."

During that time, doctors wanted to help, drug companies wanted to sell product and even federal agencies were on board.

"At the same time, the government got involved and said, 'Doctors, you have to treat pain more aggressively.' It was mandated through hospitals and (there) was a big push for that," Kim said.

There was some very early research suggesting addiction shouldn't be a concern, but clearly, that has turned out to be wrong.

"What we've done literally is done the largest experiment in human history on 300 million people, and we've been doing it for 30 years, and now, we have data and the data is not very pretty," Kim said. "It's very easy for ordinary people to get hooked on these drugs."

Need for change in prescribing

McGeorge said this means doctors need to change how they prescribe in very real ways.

"It used to be a common-shift practice that a lot of patients walked out with opiate scripts and now it's a handful at most," Pugliese said.

"As physicians, if we do decide to initiate opioids, we have to do our due diligence to protect society and patients -- you need to look at the medical history, you need to assess the risk, you need to have this discussion with the patient and you have to document that there is some pathology there," Kim said. "And then (check) that you've exhausted other therapies."

McGeorge said when doctors use opiates, they dispense fewer pills and choose the least potent or addictive medication that will manage the pain.

"Another reality of practicing medicine is that doctors also need to play detective when it comes to patients with chronic pain or any suspicion of addiction or abuse," McGeorge said. "Many states require doctors to run a patient's name through a database before prescribing narcotics, and all but one state encourage doctors to look up a patient's prescription history."

Added Kim, "There's a small minority of patients who are drug seeking that will come to any doctor's office, and those are fairly easy to see, and sometimes, you have to be brave and say no because one thing we as physicians have is a duty not to just protect our patients, but to protect society, as well. We have a legal duty to do so."

However, saying no is not always straightforward.

"You get called names on a regular basis. Plenty of people of people will scream at you," Pugliese said.

According to research published by Kim, the risk can be greater.

"The No. 1 cause of violence toward physicians in the pain group had to do with opioids," Kim said. "The precautions that some of these pain physicians have done, they've actually, some of them carry guns in their offices. Some of them carry body armor. Some people have security systems within their offices, but like I said, this is the world we live in nowadays."

McGeorge said all of this means patients should expect more direct candid discussions about why narcotic pain medications are dangerous, and shouldn't be used without careful consideration of the real risks involved.

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