How one doctor battles opioid abuse in his practice

The opioid crisis that has been brewing in this country is finally in the spotlight from Capitol Hill to statehouses around the country.

BLOG: America's Self-inflicted opioid crisis

As a frontline physician practicing in one of the hardest-hit states (Ohio), I agree wholeheartedly with Keith Martin, Medical Economics editorial director, who states very eloquently in his First Take column in this issue that finger pointing won’t do anything to solve the problem, and that efforts to tackle the opioid crisis should and will be led by physicians working in conjunction with a variety of stakeholders throughout the system.

In a recent Medical Economics poll, nearly half of physician respondents said that concern over patient satisfaction scores influenced their opioid prescription behavior. I witnessed this first- hand when I picked up shifts in a local emergency department. Some of the first words out of patients’ mouths were, “I need something for the pain.” Patients knew how to work the system and nine times out of 10, they walked out with a prescription for an opioid-based pain medication and the hospital received a high satisfaction score from the patient.  

The problem has reached such proportions that you may be asking yourself, “What can I do as a physician that may help my patients, my community and my practice get through this crisis?” 

FURTHER READING: Isn't it time for a 21st Century Pain assessment?

I have a private practice and an Urgent Care Center with more than 4,000 active patients in Youngstown, one of the most depressed communities in Ohio. Youngstown is not only economically challenged but addiction is rampant due in part to a large street drug trade in  heroin, which is now cheaper than prescription opioids.

Next: Here's what I did

In an effort to battle abuse in my practice, I decided to start by instituting very strict guidelines in prescribing and managing opioids. My patients are required to sign a controlled substance contract, where I outline what I plan to prescribe them. I require these patients to undergo random drug screens and pill counts, and I complete an Ohio Automated Rx Reporting System report to track each controlled substance prescription.

RELATED READING: Risk management lessons from an opioid trial

Patients must show up for screening and counts. Failure to comply results in dismissal from the practice.  As a result of these requirements, I have an extremely low percentage of my patients taking opioids. 

In the grand scheme of things, what I do in my practice may seem insignificant when faced with the scope of the problem across this great nation. However, to quote General Creighton Williams Abrams Jr., who commanded the U.S. military in the Vietnam War, “when eating an elephant take one bite at a time.”  

MORE OPIOID COVERAGE: Pain is not the fifth vital sign

What are you doing in your community or practice?  

George G. Ellis, Jr., MD, is an internist practicing in Youngstown, Ohio, and the chief medical adviser for Medical Economics. How are you helping patients deal with opioid issues?
Tell us at medec@ubm.com.