The state of prescription opioid abuse in America has steadily been on the rise. According to a report from the Centers for Disease Control and Prevention, nearly 2 million people had become dependent on or had abused prescription opioids in 2014. While many states have put prescription drug monitoring programs in place to combat the ongoing problem, Missouri remains the only state without one. KRCU’sMarissanne Lewis-Thompson spoke with Dr. Joel Ray, a neurosurgeon at Saint Francis Medical Center about why prescription opioid abuse has become more problematic in recent years.
Lewis-Thompson: How does a patient become addicted or dependent on prescription opioids?
Ray: Well, I think that that's a perfectly said concept. It actually changes the makeup of your body. Your body becomes dependent on it. There are some people that can become addicted to so many different things. They can become addicted to alcohol. They can become addicted to gambling. I think one of the best known mechanisms is when you become addicted narcotics it literally changes how your body works. It changes the metabolic pattern. It changes what your thinking is. It can actually in a sense change the brain neuron interactions as to what they are going to do and how they go to get that. So, it's no longer, 'I would like to go have a narcotic.' It's like 'I have to have this narcotic, I can't live without it.'
Lewis-Thompson: As a physician, how would you know if one of your patients was addicted to a substance like that?
Ray: Well they have a variety of lab tests that you can do to see if they have those products in their system. But I think that there are other indicators--behaviors. So, you can send them to do a variety of psychological tests. You can look at habits that they've developed if the patient or family tells you honestly what they've been doing. Because the whole life system changes.
Lewis-Thompson: So as you're well aware of Missouri doesn't have a prescription drug monitoring program, and in some ways that can unfortunately limit physicians and pharmacist as far as the amount of control they have about knowing if a patient is addicted to an opioid or not. So, does that change the way that you work as a doctor.
Ray: I think that we can speak directly to that point and then look at the broader picture of health care systems in the country today where we're really struggling to deal with getting a result--an outcome. We're struggling with dealing with the cost of medicine. And then we're also truly struggling with the concept of the doctor patient relationship. And so, those are three areas that I tend to look at when I'm trying to help a patient. In Missouri, it is true that we're really the only state that doesn't have that program and I know that the legislature is working on it. The Missouri Hospital Association is working on it. The Missouri Medical Association is working on it, and I think there's a very strong acknowledgement that there's a problem. But trying to solve it ends up being in the hands of organizations as they try to understand well if you put "this" into effect will it actually get you the result. So when they end up writing this legislation or the laws, the regulatory aspects their goal is going to be to end up with something that helps and doesn't just put a new law or regulation into place. But I think that you will find there's a pretty strong agreement amongst all those organizations to get to some type of an algorithm for what do you do when these drugs are being increasingly abused, when there are patterns to the abuse, and when you have most of the rest of the country that's figured it out. I think they're going to end up figuring that out in Missouri.
Lewis-Thompson: What have you seen from your own patients or learned from other doctors about the issues of opioid abuse in this particular area?
Ray: I came here almost 20 years ago from San Diego and I thought that since that was right on the boarder that was like "the place," but actually Southeast Missouri has a huge problem with narcotics and other illicit drugs. I don't know that if I've totally figured it out for myself, but it's extremely prevalent. It's worse. I've worked in the emergency room and watched highway patrol officers coming in and trying to understand why the people in the emergency room that they have have gotten into trouble. There are all kinds of trafficking issues. I know that Cape Girardeau has great police force, but they're putting an awful lot of resources into trying to manage because you're right on the river. So there's real easy trafficking in this stuff. So, in almost every arena for my own patients, to the emergency room, to my peers we discuss this frequently. When you put on top of that that there are struggles within the health care system for patients to access health care so that they don't have family doctors you know especially in rural community Southeast Missouri is a rural community. So just getting access to a consistent doctor patient relationship has been tough.
Lewis-Thompson: What is the process at Saint Francis Medical Center for regulating those types of medications?
Ray: Well they have a wonderful pain management department. And I can clearly speak for myself that I'm a neurosurgeon. Ideal patients that have pain. But if I'm going to have patient that's on long-term addictive medications then I uniformly refer them to the pain management department. And I think many of the primary providers do that. If we can get them to a steady state where we can monitor them and we feel it's working then I think the primary providers can take that over once it's established. The pain management departments use incredibly strict protocols for testing the patient to see if they've stayed on track with the orders that are provided. We still have issues though with patients who don't follow those regulations and I don't think we've totally solved what to do with those patients.
That was Dr. Joel Ray, a neurosurgeon at Saint Francis Medical Center.
