It’s a scenario that has become increasingly common. A patient sees their doctor seeking treatment for chronic pain, and the doctor prescribes high-strength opioid pain medication in efforts to help.
But over time, the patient becomes addicted to the medication, setting off a vicious cycle.
It’s a cycle Ellis County physician clinics and therapists are hoping to help break.
A community meeting was hosted by First Care Clinic of Hays and Victoria last fall, inviting medical professionals from all sectors to learn about the growing opioid addiction problem and brainstorm ways to stop it.
“We see some patients come to us with chronic pain,” said Bryan Brady, CEO of First Care Clinic, 105 W. 13th. “We see more patients come to us addicted, though. And they have been put on it by whoever. I think there’s good intent with it, but these opioids should not be used as a front-line defense for chronic pain. They are more for acute pain and short-term use.”
The federal Centers for Disease Control in 2016 released data showing Ellis County has one of the highest opioid prescribing rates in Kansas. The national prescribing rate is 66.5 per 100 people, with Kansas at an average of 76.9. Ellis County far exceeds that amount at 107.9, said Kimberly Koerner, who works at Hays Medical Center as infection prevention officer and is studying the issue for her master’s degree program.
“When I compared Ellis County to surrounding counties, I discovered that overall, Finney County averaged 74.2 per 100 person, Geary 62.8 per 100 person, and Lyons 76.6 per 100 person,” Koerner wrote in an email.
Prescribing practices also can be compared using morphine milligram equivalents. High dose is considered more than 90 MME per person, with a national average around 640. Ellis County’s average is a shocking 973 MME per person, Koerner said.
According to Centers for Medicare and Medicaid Services, the national average of prescription duration is 17.6 days per person. In Hays, the average supply lasts 20 days per person.
“The length or number of days supplied also influence opioid use, misuse and overdoses,” Koerner said.
Opioid overdose in 2016 was identified as the leading cause of accidental deaths in the United States. In 2011, the Kansas Department of Health and Environment reported one in three Kansas poisonings were related to opioids.
‘Changing the way we practice medicine’
First Care Clinic last year set out to change the way its physicians practice medicine by working to ensure opioids only are prescribed when necessary and for appropriate lengths of time, Brady said.
“This is not specific to our patient population. … This is everybody’s problem,” Brady said. “What we found though is by denying patients access to these medications, they were probably just going somewhere else to get them, whether it be an ER or a different provider in a different county.”
To address that challenge, local healthcare providers are working to collaborate. The October meeting was a step toward building a network of community partners willing to address chronic pain outside of opioid treatment. The network so far includes physicians, chiropractors, physical therapists and massage therapists who offer alternative, drug-free therapies. Several pharmacists also attended the community meeting.
“We’ve not met anybody who says, ‘No, this is not a problem,” Brady said. “Once they’re shown the data, it’s like, ‘Oh my goodness.’ ”
First Care Clinic physicians now address chronic pain by referring a “front line” therapy first, such as physical therapy, dry needling, cryotherapy or chiropractic care, Brady said. Participating therapists then are asked to correspond with the physicians to confirm patients attempted their prescribed alternative treatment.
When opiate pain medication is determined necessary, patients are asked to enter a “narcotic contract” in order to receive the prescriptions from First Care physicians. That contract requires patients to have annual wellness exams, random drug testing, possible random pill counts and no early medicine refills.
Patients also are asked to commit to seeing only First Care physicians and using one pharmacy. A statewide pharmaceutical drug monitoring program also is used to track patients’ prescription activity.
The results of the clinic’s new practices have been promising. In just two years, First Care Clinic saw a 74-percent drop in the number of opiate prescriptions.
In 2015, the clinic prescribed nearly 14,000 total medications, with more than 1,300 of those -- about 10 percent -- for opiate drugs. Their number of opiate prescriptions dropped to only 346 by the end of 2017, totaling about 3 percent of all medications given.
Over the same two-year period, physicians identified approximately 200 patients who were abusing or misusing their prescription drugs.
“We have really changed the way that we’re practicing medicine here, and we have denied a lot of people continued opioids over the past year and a half because they’re not using them correctly,” Brady said.
Opioid drug use can cause unintended consequences such as addiction because “there’s no end game to them,” he said. Patients over time can develop an increased tolerance for the drug, causing physicians at times to up the dosage for effectiveness.
“That’s where we get people in trouble, and that’s what we want to make sure we’re not promoting,” Brady said, noting the clinic still takes issues of chronic pain seriously and wants to help. “We want to give people actual relief to be able to manage their pain and to bring functionality back to their lives.”
New protocols are being implemented at the clinic this year to better gauge patients’ pain levels by changing from a scale of one to 10 to questions of daily functionality and physical capabilities.
“We don’t make light of people with chronic pain. They believe they’re in pain and we want to make sure we’ve got something we can do to help them,” he said. “It’s not something that can be treated lightly -- it’s just that we’ve treated it the wrong way for so long.”