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Another view - Opioids must be carefully controlled

Stuart News - 4/9/2018

Opioids have a role to play in health care, but only in a carefully controlled regimen.

There are people with pain who need them – not to get high, but to have a quality of life. The problem came in recent years with opioids being used as drugs of first choice.

A new study shows that patients who took opioids did no better than those with safer options such as Tylenol and ibuprofen. Results of the clinical trial were reported in the Journal of the American Medical Association. The trial enrolled patients who were treated by the Minneapolis Veterans Administration for pain the back, knees or hips.

The pain had to have lasted for six months and interfered with daily activities. Patients were randomly assigned to an opioid or non-opioid group.

After a year of pain treatment, researchers saw no evidence that opioids produced better outcomes than the non-opioid alternatives.

Overdoses skyrocket

Emergency rooms last year recorded a big increase in overdoses from opioids, according to a report from the Centers for Disease Control and Prevention. Overdoses from opioids increased by 30 percent last summer compared to the same three-month period a year earlier.

The biggest increases were in the Midwest's cities, though the impact was seen nationally. The numbers probably are low since the CDC doesn't track all the ERs and not all those who overdose go to the hospital. Most of the overdoses were not fatal. However, the increased illegal use of fentanyl is producing a rise in deaths.

Medicine of future

The health care system really doesn't act like the free market. In an age of instant communication, consumers are often left helpless by lack of knowledge in the quality and cost of health care. But there is hope, described in a news story by Kaiser Health News.

Patients sometimes can shop for medical procedures and get money back if they make smart choices. Insurance programs of state public employees were the first to adopt the money-back approach. Pick a pre-qualified provider for a mammogram and get a $50 check in the mail. What a deal. One consumer was getting a $25 check every few weeks for going to a specific lab for tests.

"If insurance plans were serious about saving money, they would have been doing this stuff years ago," said Josh Archambault of the Foundation for Government Accountability in Naples.

Another idea allows consumers to go outside networks for care if comparable services cost less than the average price insurers pay in network.

Hospitals of future

Hospitals are changing fast. Here come outpatient clinics, same-day surgery centers, freestanding emergency centers and microhospitals. With digital technology, patients can be monitored at home, which means less cost and less chance of catching a hospital-acquired infection.

"Traditional hospital care is too costly and inefficient for many medical issues," The Wall Street Journal reported.

The U.S. has more hospital beds than it needs with an average hospital occupancy rate of just 62 percent in 2015. In fact, there were more hospital closings than openings in the four years ending in 2015. About half of them converted to outpatient facilities. Full-service hospitals will be needed for trauma cases, complex cases, risky procedures and the sickest patients.

Coming soon will be hospital-level care at home for up to half the cost of traditional hospital care. It offers fewer complications and lower mortality rates. One expert says that 30 percent of today's hospital care can be delivered at home.