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By Scott McKinney Ph.D.
Imagine if, as a society, we were unable to be good parents. The resulting context would be a greater need for individuals and groups providing a solution to the problem. One could imagine that the child care industry would grow in proportion to the need for quality care, that schools would adapt to meet demands and that society would debate what we need to do to be better parents. The problem is that none of these measures replace the power of good parenting and that the solution has never been really oriented towards the problem. It may seem absurd, but something very similar – a product of regulation – is fueling the opioid epidemic. This something is negligence.
Scott McKinney
The opioid epidemic is the subject of almost all television and radio programs. The US Department of Health and Human Services has declared a public health crisis in 2017. This is such an important topic that our President has probably tweeted about it. The new administration policy focuses on the fight against crime and on vague promises of harm reduction and treatment. Our regulators debate, campaign and vote on issues of border control and over-regulation of doctors, but no one speaks of mother, father, spouse or wife typical who deals with chronic pain problems. While the broom of regulation sweeps our country, in a normal and functional way, people are brushed by a bristly silk. The story, now common, of a person struggling with chronic pain goes a bit like this.
They have an accident or an unfortunate diagnosis. They seek medical care for the pain and the path usually leads to the prescription of opioids. The years go by, everything is managed. Of course, their tolerance to prescription drugs has increased, as has their dose. One day, they go to what appears to be a typical follow-up appointment with their provider. The provider, who suffers from increasing "regulatory anxiety", informs the person that they will no longer be able to write their prescription and will need to direct it to another provider. This seems pretty simple in the mind of the individual. Unfortunately, they quickly learn that it is more than an anomaly; it's a growing trend. After innumerable calls and searches on Google, they discover that other doctors refuse to take charge of their care or are indicted by the federal government. The problem has become critical. The clock has now started for a person who will miss drugs allowing him to function normally. Their controlled pain will begin to ravage their ability to function and the quality of their lives in general. And, of course, do not forget the withdrawal that they will soon suffer. Unknown to them at the time, they joined the unnamed.
Patients are put into this exact scenario every day around us. They are forced to look for non-opioid solutions to their chronic pain problems, which may not provide the same level of function they had before or seek the only treatment available to people who are dependent on mood-altering chemicals. They are told that they do not need opioids or that they need treatment for addiction.
This is becoming a regular story in the field of addiction treatment. Opioid-dependent patients, without providers being willing to respond to their needs, seek comfort in an area that will provide them with care. The problem is that drug treatment centers are ill equipped to take care of these patients. Many do not meet the diagnostic criteria for addiction and have a primary diagnosis of chronic pain. Between the treatment of chronic pain and the ability to correctly diagnose the problem, many providers need to create "pain management for addiction" programs specific to this population or only address addiction resulting from a problem. worse. Like the problem of bad parenting, we do not deal with the source of the problem.
If we want to start correcting this problem, we must first recognize the population being discussed. Yes, we must hold doctors accountable when they prescribe opioids for pain relief. But, there is also a lack of differentiation between substance abuse disorder and substance dependence. So who are we talking about in the first place? The Update of the Additional Criteria for Substance Use Disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) results in a series of diagnostic codes that neglect patients with chemically-dependent chronic pain dependent; they do not have a diagnosis identifier unless they are classified as drug addicts.
How can we start helping a population that does not even have a name? This is problematic in two ways. Once she leaves the pain and dependency professionals without the appropriate diagnostic label for this population. Secondly, drugs and services without adequate diagnosis are not covered by health insurers. Thus, they are either misdiagnosed or simply rejected in one direction. A modification of the DSM-V must be made to take into account the criteria necessary to substantiate chemical dependence or an additional set of ICD-10 codes for chemically dependent persons who do not meet the criteria for a chemical dependence. substance abuse. As we continue to discuss the problem of opioids, dependent patients, but not abusing opioid prescriptions, are as important as those who use drugs or use illicit substances. They are all our neighbors, friends and family.
Dr. Scott McKinney is President of the Midwest Institute for Addiction. He served in the United States Marine Corps as a naval veteran and fighter. His passions brought him from the world of physiotherapy and human performance to those addicts and addicts. He continues to find opportunities to work for the good of others.
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