FORT WAYNE — Health care professionals shared stories from the frontline of the opioid crisis during a recent panel discussion hosted by Visiting Nurse, a nonprofit that provides end-of-life and palliative care.
The Feb. 28 event, the second in Visiting Nurse’s “Everyone’s Epidemic” speaker series, featured three local physicians who discussed how the opioid epidemic and substance use disorder have impacted health care on a local and national level.
The panel included Allen County Health Commissioner Dr. Deborah McMahan; Dr. Matthew Runyan, a psychiatrist with Parkview Health; and Dr. Ann Moore, chief medical officer at Visiting Nurse.
Dealing with underlying issues
For years, doctors commonly prescribed opioids to treat pain without understanding the dangerous complexities of the drug, McMahan said. The medical community now understands that some people have a genetic predisposition to becoming addicted and others, who suffer from anxiety and depression, use the painkiller to alleviate their mental anguish.
Runyan said he sees a lot of overlap in mental health and substance use disorder, including patients with a history of trauma. Post-traumatic stress disorder is not just something that combat veterans suffer from, he said.
Some individuals with PTSD will self-medicate with illicit drugs because getting high makes them not care about their problems. For this reason, dealing with underlying mental health issues is critical to addressing addiction, he said.
Consequences of crackdown
In recent years, prescriptions for opioid painkillers have decreased sharply. While this was a well-intentioned shift in prescribing practices, it had unintended consequences, McMahan said.
Many patients who were addicted to their prescribed opioids turned to illegal drugs like heroin because they were cheaper than buying prescription painkillers on the street.
“Instead of spending $150 on pills, (someone) can spend $60 on heroin. It’s a lot easier,” Runyan said.
According to the Fort Wayne-Allen County Department of Health, 126 deaths resulted from drug overdoses in 2017 — an increase of 70 percent from the previous year.
“For mental health and medicine, this is the (Hurricane) Katrina for us,” McMahan said, describing the scope of the epidemic.
In addition to the cost of human lives, the crisis is also closely linked to an increase in the spread of infectious diseases, including HIV, hepatitis A and hepatitis C, due to users’ risky behaviors like sharing needles, she said.
While communities have increased their capacities to address the epidemic with medication-assisted treatment centers to treat people who are addicted to opioid-based drugs, McMahan said another illicit drug has risen in popularity: meth.
Treating a patient who is addicted to meth presents different challenges than treating a patient who is addicted to opioids, she said. Individuals who use meth might be less motivated to seek treatment because they don’t get “dope sick,” that is they don’t feel the effects of withdraw as severely as individuals who use heroin, she said. Also, there is no medication approved to treat addiction to meth.
Physicians navigate new guidelines
In response to the opioid epidemic, state lawmakers have recently expanded access to Inspect, a database that logs what controlled substances a patient has been prescribed as well as the doctor who prescribed it and the pharmacy that filled the prescription. The goal is to ultimately require all medical practitioners to refer to the database by 2021.
Runyan said the database has been a powerful tool to identify individuals who are trying to get multiple prescriptions for controlled substances. Inspect allows him to run a search that includes data from multiple states.
Stricter prescribing laws have made doctors more informed, but they have also made it harder for some patients to get the medicine that they need.
Moore practices exclusively in hospice and palliative medicine and treats patients who have terminal or life-threatening diseases. She regularly fields calls from pharmacies confirming that she did indeed prescribe certain medications.
“I want those phone calls, because if they’re calling me and they’re calling my team — and they know the type of medicine that we’re practicing in the community — they’re also calling the other doctors who may not do this on a daily basis,” she said.
That said, the additional layer of oversight is burdensome at times. Communicating with insurance companies to justify why she is prescribing certain medications is almost a full-time job.
“I had my nurse on the phone today for 51 minutes with one insurance company trying to get a pain medicine for a cancer patient,” she said.
Generally, the new guidelines also mean more paperwork, added stress, less time with patients and less job satisfaction for health care professionals, she said.
McMahan encouraged the health care professionals who attended the panel to reach out to policy makers and make their voices heard and their stories known.
“I can’t imagine that you’re not all impacted by this. The reality is you can suffer alone or you can start letting the policy makers know, ‘You work for me and at least this is what I think should be done right now.’”
The next event in Visiting Nurse’s “Everyone’s Epidemic” speaker series is “Signs of substance use disorder in children and family members” featuring Captain Kevin Hunter of the Fort Wayne Police Department Vice and Narcotics Division. The event is free and open to the community and begins at 5:30 p.m. at the Peggy F. Murphy Community Grief Center, 5920 Homestead Road, Fort Wayne. Call (260) 435-3261 to RSVP.
Everyone’s Epidemic Speaker Series is free and open to the community. Each discussion begins at 5:30 p.m. at the Peggy F. Murphy Community Grief Center, 5920 Homestead Road, Fort Wayne. Call (260) 435-3261 to RSVP.
April 23: “Sharing My Healing Pathway” featuring Dr. Carolyn Greer, Andrea Schroeder and David Wust
May 16: “Signs of Substance Use Disorder in Children and Family Members” featuring Captain Kevin Hunter of the Fort Wayne Police Department Vice and Narcotics Division