JANESVILLE—Physicians have two responsibilities when trying to slow the opioid epidemic, says Dr. Arthur Altbuch, an addictionology and chronic pain specialist at Mercyhealth.
The first is to acknowledge that opioid prescriptions are part of the problem. The second is to treat the problem that those who prescribe drugs helped start.
“If you broke it, you gotta fix it,” Altbuch said.
The three most prescribed controlled substance medications in Rock County are opioids, according to data from the Prescription Drug Monitoring Program.
Opioids were involved in 988 hospital encounters and 28 deaths in Rock County in 2016, according to the Wisconsin Department of Health Services.
Hydrocodone-acetaminophen—known as Norco, Vicodin or Lortab—is the most prescribed controlled medication in Rock County, making up 20 percent of all prescriptions, according to the drug monitoring program.
Other popular prescribed controlled medications include oxycodone with acetaminophen—known as Percocet—and oxycodone HCl. Those drugs each make up 7 percent of total controlled prescriptions, according to the program.
More than half of all controlled medications prescribed in Rock County are opioids—51 percent of the drugs dispensed, according to the program. Neighboring Walworth and Green counties dispense 46 and 45 percent opioids, respectively.
High numbers of opioid prescriptions are a result of an aggressive push for opioid pain treatment in the 1990s and early 2000s, Altbuch said.
At that time, physicians were told the risks involved with prescription opioids were low, he said. Years later, however, those reports were debunked.
The effort to reduce the numbers of prescriptions and patients’ requests for the drugs is slowly progressing, Altbuch said. Educational programs about the drugs’ risks of opioids are starting to show results, he said, but it will take time before the full impact is seen.
High numbers of prescriptions also can be attributed to how prescriptions are reported, he said.
Physicians often start patients on three-day opioid prescriptions, Altbuch said. That means a prescriber may have to write prescriptions more frequently depending on how long the patient needs the drugs.
State Rep. Debra Kolste, D-Janesville, has sponsored legislation to create and maintain the prescription monitoring program. She said Rock County’s numbers might be high because health care is accessible here. More prescribers mean more access to prescriptions.
WHERE DO THEY COME FROM
Doctors make up the majority of prescribers in Rock County, according to Prescription Drug Monitoring Program data. About 55 percent of hydrocodone-acetaminophen is prescribed by doctors.
Nurse practitioners are the second most frequent prescribers, according to the program.
State law requires prescribers to consult with the program before prescribing medications, Altbuch said. Doing that requires extra “clunky” steps, which he thinks keeps some physicians from immediately prescribing medications.
Doses of all prescription medications have decreased at the state and local levels, according to the monitoring program.
In Rock County, 23.85 doses of prescription medication are prescribed per capita, according to the program. That’s down from 27.88 in 2016 and 31.36 in 2015.
Kolste said Wisconsin saw fewer opioid prescriptions immediately after the monitoring started in 2013. She believes the first step in slowing the epidemic is to control the number of opioids given out.
Statewide, Rock County ranks high in doses of controlled prescription medications per capita, according to the monitoring program. Out of 72 counties, Rock County is 17th-highest in doses per capita.
WHAT CAN BE DONE?
Not enough data are available to prove opioids are effective in treating chronic pain, Kolste said. The more people are subjected to opioids, the more they become addicted, she said.
Prescribers are not the only ones to blame for the opioid epidemic, Kolste said. She also blames pharmaceutical companies for convincing prescribers and consumers that opioids are safe.
But saying no one benefits from opioid pain medication is oversimplifying the problem, Altbuch said.
He recommends that physicians perform a risk assessment on each patient before writing prescriptions.
Some people are more prone to addiction based on genetic and psycho-social factors, Altbuch said. Family history of opioid use, prior opioid use, bipolar disorder, chronic depression, sexual abuse and domestic violence are all factors that could make someone more prone to addiction.
With careful attention to risks and proper dosage, opioids can help manage pain, he said. But he emphasizes that no method is foolproof.
Alternative approaches do exist for treating chronic pain, Altbuch said, including exercise, physical therapy and acupuncture.
Altbuch said he lets his patients explore the options they think could solve their problems. He finds people are empowered and motivated to get treatment when they have ownership over it.