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ER pediatrician: Doctors' prescribing practices affect opioid abuse

| Thursday, Feb. 8, 2018, 8:55 p.m.
The National Safety Council's Opioid Memorial at The University of Pittsburgh on Monday, Jan. 29, 2018.
Nate Smallwood | Tribune-Review
The National Safety Council's Opioid Memorial at The University of Pittsburgh on Monday, Jan. 29, 2018.

Life expectancy for Americans has declined for the second straight year — something that hasn't been seen in more than half a century. Some have partially attributed this decline to the number of people dying from opioid overdoses. This decline has occurred despite a nationwide reduction in the number of opioid prescriptions being written by physicians.

For many people who abuse opioids, their first exposure often comes from people like me — physicians. As a pediatrician who works in an emergency department, I often prescribe opioids for children who have significant bone fractures. The colleagues and mentors I've worked with over the years do not intend to provide medications that become the gateway to drug abuse later in life. However, physicians can do an even better job of making evidence-based decisions when it comes to opioid-prescribing practices.

Our patients and communities have entrusted us to regulate ourselves. We must consistently improve to provide the best care for our patients. To that end, there are a number of things we can do to address the scourge of opioid abuse.

Our medical societies and governing bodies can support compulsory continuing education regarding opioid prescribing to ensure that all providers are aware of the latest evidence-based approaches to managing pain.

Many budding physicians write their first opioid prescription during their residencies. A recent study showed that such residents are more likely than other providers to prescribe opioids for longer than five days. The governing body overseeing medical education could outline specialty-specific opioid-prescribing recommendations to be taught to all residents. This would help ensure our newly minted physicians have a standardized, evidence-based foundation in pain management.

If a patient overdoses on opioids and is seen in an emergency department, we should ensure that he or she has a scheduled follow-up appointment to be seen by an addiction-specialty professional.

Physicians can empower the autonomy of patients and families. Not all pain necessarily requires opioids. In cases where opioids may help and are appropriate, physicians can allow the patient (or a family member) to decide on an opioid- or non-opioid-based form of pain relief.

We can also work in our communities to train people in how to recognize the signs of drug overdose, the appropriate use of an antidote and how to protect oneself when working with people who are suspected to have overdosed on opioids.

I recognize that generic solutions can have unintended adverse consequences. We do need to ensure that certain patients have access to opioids in quantities and durations supported by sound conclusions from evidence-based scientific studies, while working to minimize abuse.

For me, this sense of urgency is both professional and personal. As a pediatrician, I advocate for my patients, who cannot always advocate for themselves. As a soon-to-be father, I am unnerved that my child is predicted to have less longevity than if he/she were born earlier. Because people's lives hang in the balance, we as a society cannot afford to wait until the next report on life expectancy is released to meaningfully address this opioid epidemic.

David E. Myles is a board-certified pediatrician and fellow of the American Academy of Pediatrics.

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