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Fighting the good fight: Kentucky physicians take leading role in opioid crisis

Messenger-Inquirer - 10/15/2017

Oct. 15--Whether facing a severe sickness or the birth of a child, doctors are the experts we rely on to lead us through matters of life and death; their experience and wisdom helping to inform on the best options for our lives.

But where do communities turn when afflicted by a crisis that seems hard to grasp and even harder to stop?

One program is training Kentucky physicians to extend their leadership role to help communities tackle and heal from difficult public health issues such as the opioid epidemic ravaging cities and towns across the state.

Dr. Philip Hurley of Orthopaedics and Sports Medicine Owensboro is one of the doctors returning to his community with a mission after completing the inaugural class of the Kentucky Physician Leadership Institute created by the Kentucky Medical Association.

Hurley said the training he has received from the program has already affected the way he relates to his patients, but the real impact for doctors will come from applying the lessons learned with their own passion for the people they serve and the problems they face.

"When you finish the program, it's up to you to become active in your community, practice, hospital or region," Hurley said.

The institute conducted training sessions between July and August with their final course taking place at the annual KMA conference in Louisville. During four sessions, Hurley and nine other physicians from across the state learned aspects of personal and business leadership, spoke with state legislators and a Supreme Court justice about medical policy.

The advocacy portion of the training and the KMA's annual conference focused on giving physicians resources to help them support their colleagues and patients while taking an active role in preventing more opioid-related fatalities.

Kentucky has seen a growing number of fatalities because of drugs, with data from the Centers for Disease Control and Prevention reporting a 21 percent increase between 2014 and 2015.

Daviess County has seen 77 fatal overdoses since 2012, with the majority occurring in the past three years.

Hurley said he has taken the impact of opioids in the region seriously but realizes the storm of addiction grown out of decades of issues around the drugs will take time and hard work to change.

"It's kind of like steering a battleship; we can't turn on a dime," Hurley said. "This is something we would all like to change quickly, but if we don't try, it won't be fixed."

Hurley has started working to support physicians in Daviess County by using resources from the KPLI to invite Leanne K. Diakov, general counsel for the KentuckyBoard of Medical Licensure, to Owensboro for an informational session on a new opioid prescribing regulation.

House Bill 333 signed into law in April by Gov. Matt Bevin restricts supplies of opioid medications for acute conditions to a three-day maximum supply to prevent unnecessary overprescribing that could result in addiction.

A 2015 report from the Centers for Disease Control and Prevention found that chronic opioid dependence for noncancer related pain occurred in 26 percent of patients nationally. One out of every 550 patients that started on opioid therapy died of opioid-related causes a median of 2.6 years after their first opioid prescription.

A report from the Kentucky Office of Drug Control policy documenting the more than 1,400 fatal overdoses in the state showed prescription drugs were detected in 61 percent of overdose deaths.

Pat Patrick, KMA executive vice president, said the House bill is also a prime example of why physicians have a role to play in solving the opioid crisis. Patrick said the bill was pretty absolute when it was first drafted and didn't contain exceptions for cancer patients and other severe cases of pain until legislators heard from KMA physicians.

"Doctors are the ones who see what is going on; they are the one who see the patients more than anyone," Patrick said. "They have a unique voice to share on how to fix issues with the opioid crisis."

Patrick said the exposure doctors have in seeing people looking for access to opioids and their use of the state prescription reporting system known as KASPER positions them to make suggestions that could improve drug policies. By giving physicians the experience of communicating with politicians and policymakers, he said they will be able to put that experience to work for their communities.

In Owensboro, Hurley said his experience as an orthopaedist helping people with pain and the desire to learn more about the problems caused by opioids has changed some of his approach with patients.

"I don't treat patients differently based on personal judgment," Hurley said. "I would treat my patients that are athletes different than I would older people. Part of my oath as a physician is to treat my patients the same on a personal level, but treat them medically in the most effective way."

He said he has started to have more candid conversations with patients about their history with medications and might change his monitoring and prescription practices for a patient struggling with substance abuse. Patients are also becoming more forthright, letting him know of past issues with addiction before he prescribes.

In the past, information available about opioids and initiatives for doctors to treat pain as the "fourth vital sign" led doctors and patients to trust the medication for even acute incidents.

Hurley said he and other physicians now take precautions with "opioid naive" patients who may have never taken the medication.

"Drugs were presented to doctors and the public in a less worrisome light in the past," Hurley said. "There are a lot of problems with drugs that aren't found until after they are released to the market and have a chance to be tested by a much larger group of people. Now we have no question people are becoming addicted and we have to take caution."

Van Ingram, executive director for the Kentucky Office of Drug Control Policy, said the trust and respect physicians have in their communities make them excellent leaders in fighting the opioid crisis, but patients also have a role to play in assisting them.

"For us to ever mitigate this epidemic we are in, we have to mitigate the expectations we have ourselves as patients," Ingram said. "A pain-free experience isn't realistic, and opioid medications aren't appropriate in every situation."

Ingram said he has seen more physicians begin to speak up and become involved along with other advocacy groups across the state. He said he has hopes for the voice physicians can lend to reduce the stigma around substance abuse, but their position could be improved by more resources.

"Substance abuse is a disease that has its unique challenges," Ingram said. "It affects judgment and thought. If you know that going in, you don't feel personally offended when people stray away."

Ingram and Hurley both cite the need for increased access of substance abuse treatment and support, especially in rural communities. Physicians may have knowledge about the effects of certain drugs but not every doctor can be an expert on addiction.

When treating a patient with chronic pain, Hurley now refers them to a chronic pain specialist as well in order to ensure they are getting the best advice.

Hurley said part of his new mission is connecting local physicians and working with the families of patients to help communities and individuals heal.

"If you're an addict with broken bones, my job is to treat your pain, but I have to be more judicious and work with families to ensure the best outcome for everyone," Hurley said.

Jacob Dick, 270-228-2837, jdick@messenger-inquirer.com,Twitter: @jdickjournalism

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(c)2017 the Messenger-Inquirer (Owensboro, Ky.)

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