Dr. Haney Assaad of the North Ottawa Medical Group said the first step is exploring different options, and not quickly jumping to painkillers.
“There are a lot of alternatives you can go through first — including physical therapy, muscle relaxers, anti-inflammatories,” the internist said. “There's a whole host of other options first.”
Assaad explained that when a patient comes in, his initial action is to figure out the root of their pain, and what they have done so far for it — whether they have tried to treat it, have had X-rays, or done anything more than look for pain pills.
“You try other things to try to treat their pain with other medications that are appropriate for the pain and not necessarily opioids,” Assaad said. “Then you try to get them to the pain clinic, orthopedics, whatever modality, or physical therapy ... or sports medicine. There’s a lot of places to go where maybe their pain can actually be treated rather than treated with pain medicine. So you try to go that route.
“Then, in the end, if God forbid they have to be on pain medicine for a prolonged period, there's a lot of mechanisms you have to also go through to protect them from addiction and overuse,” he added.
Since the crisis has worsened in recent years, doctor offices have also upped their watch on controlled substances and the patients prescribed to them. Assaad said offices like his use prescription contracts that state people will not misuse them or take more than they’re supposed to, or indulge in other drugs while taking them.
“We track every pain prescription we ever give through the computer,” Assaad said. “So, when you come for a refill, it's electronic, so to refill it, it shows the last date and quantity. Every physician has the ability to look up and track all the controlled substances a patient has gotten.”
The doctor noted that the Michigan Automated Prescription System monitors all controlled substances that are prescribed within the state.
“For instance, if you decide to go from doctor to doctor, insurance will track it if you do it with your insurance,” Assaad explained. “But people will pay cash to avoid insurance being notified — they also track that. So you can’t go from my office to another office and pick up five prescriptions and go to five different pharmacies, because the pharmacy doesn’t matter, how you pay, nothing matters. It’s trackable. And it’s not just opioids — it’s all controlled substances.”
Assaad said the reason opioid abuse has become an issue now is its cumulative effect.
“If you put one person on it and they never come off it, and you add another, you’ve just doubled the crisis, so it becomes exponential,” he explained. “I think once that crisis became an issue, then it became more obvious. But I think before this, people said they had pain, (and doctors said) ‘Here you go — pain pills’ (and) never thought anything of it.”
In his 20 years of practicing medicine, Assaad says he used to be able to count on his hands the number of his patients prescribed to opiates, but no longer.
“It’s such a production in our office, it literally takes a certain percentage of the day dealing with those issues, even if the volume is not that high,” he said. “I actually have a spreadsheet of every single person on opiates on my computer, every one.”
Assaad said opioid abuse can lead to many problems.
“One of the problems with the opioid crisis is not just the fact that too many people are getting them, there’s a high risk of overdose with them, higher risk of suicide and things like that,” the doctor said. “... And the other thing that’s a problem is opioids have been known to be what’s called a gateway drug. So what that means is that you go from opiates, and when your opiates stop, they start going toward heroin.”
If someone is no longer able to receive the drug from their doctor, Assaad said patients have implied they can find them elsewhere, and noted how it is unfortunate they can get them off the street.
Avoiding pain pills at all costs is Assaad’s preference. But if someone has to be on them, constant monitoring is essential.
“If you do go to opioids, you have to be ultra-vigilant about it the entire time,” he said. “Then you have to track them continuously, make sure they’re not getting them anywhere else. It’s very time consuming. It takes a lot of office staff.
“The problem is it’s a very fine line — are you a compassionate doctor and want to treat their pain? But in the same light, are you causing a problem?”