A new study released by the UNM Pain Consultation and Treatment Center shows that a new state-mandated training program for doctors and clinicians is resulting in significantly fewer opioid painkillers being prescribed to patients, which has led to less addiction and fewer overdoses.
Dr. Joanna Katzman, associate professor of neurology and director of the UNM Pain Center, led the team that developed the training program. Katzman was also integral in writing the legislation, Senate Bill 215, which passed the New Mexico Legislature in 2012 and created the mandatory training program.
Since then, Katzman and the UNM Pain Center, with the help of other organizations around the state, have trained more than 3,000 doctors and clinicians on better, safer ways to treat serious and chronic pain.
“When you try to balance the treatment of chronic pain, which sometimes necessitates opioids, with the public health crisis of unintentional opiate overdose deaths, it becomes a tricky management issue,” Katzman said. “We wanted to teach clinicians how to take care of their patients in pain, and how to hopefully prevent these unintentional opioid overdose deaths.”
Katzman, who has worked in pain management for years, described the difficulty of balancing the real need for chronic pain management with the dangers of prescribing highly addictive, powerful and often dangerous narcotics.
Chronic pain is a huge issue affecting 100 million Americans — more than diabetes, heart disease, stroke and cancer combined, Katzman said.
“Pain trumps everything; it’s still the leading cause of disability in the country,” she said. “It costs the United States $635 billion in terms of productivity and medical costs.”
At the same time, New Mexico has been at the top of the list for opiate addiction and overdose deaths for years.
“The issue of unintentional opioid overdose deaths has been a big problem in New Mexico for many years,” Katzman said. “New Mexico has led the country in problems with both heroin and prescription opioid deaths for a decade, and it’s only been a couple of years since we’ve fallen to number two.”
The problem has reached near epidemic levels in Bernalillo County, where one in 20 teenagers is now abusing heroin and prescription opiates, Katzman said.
The problem of over-prescribing opioid painkillers has been growing, notably with the well-documented explosion of addiction and suicide among veterans being treated by the U.S. Department of Veterans Affairs.
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Other states have attempted to tackle the problem of prescription opiate addiction in a number of ways, often with mandated dosing thresholds — meaning doctors and clinicians were only allowed to prescribe a certain amount of total milligrams per year. This situation led some doctors to feel too restrained in the way they treated their patients, Katzman said.
So Katzman and others working on the state Senate bill decided to go in a different direction: mandating ongoing pain management training instead.
“What we were able to do was provide an education, not create fear. That was a really good result of this training,” she said. “Chronic pain is just as big a problem as the addiction problem. So instead of telling doctors what to do with their patients, it’s better to educate them.”
Since beginning the training, Katzman and her team have been collecting data on prescription rates and overdose deaths. Their research paper, titled “The Public Health Crisis of Chronic Pain and Addiction — Rules and Values,” showed a 16 percent drop in the morphine milligram equivalent prescribed in New Mexico between 2012 and 2014, a 16 percent drop in the valium milligram equivalent, a decline in the overdose death rate and a significant decline in the dispensing of high-dose opioids, like 80 milligram Oxycontin pills.
“Clearly they were learning that high-dose opiates were unsafe. So they were clearly benefiting from the information we are providing,” Katzman said. “The New Mexico Board of Pharmacy has seen a reduction in the dispensing of the opioid and benzodiazepine medications, and there has also been a reduction in overdose death rate as well. Our hypothesis is that this education has been very effective.”
Katzman said she believes that a lack of education about pain management in medical school, along with the increased workload and pressure to see more patients in a smaller amount of time, has contributed to the problem of over-prescribing narcotic drugs. Doctors are no longer allowed to see their patients regularly for long appointments, and often only get to spend 10 minutes with them at a time.
“Sometimes it’s easier to just write a prescription to renew their medications. I think it’s harder for doctors to have the time to learn new pain-management skills and tools.”
Katzman believes that pain specialists need to spend more time training med school and post-graduate students and doctors.
At the moment, Katzman and the UNM Pain Center are waiting for further state funding to continue their training program. Senate Bill 215 mandated that doctors must continue receiving further training, so she said she is hopeful the Legislature will vote to continue paying for the program.
“We’re at a halt right now. We’re hoping to renew our courses and we’re hoping to continue seeing the positive results from the New Mexico Board of Pharmacy,” Katzman said.
Jonathan Baca is the news editor at the Daily Lobo. He can be contacted at news@dailylobo.com, or on Twitter @JonGabrielB.
