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Charles MacLean, MD, is a primary care internal medicine physician at the UVM Medical Center and associate dean for primary care and professor at the Larner College of Medicine at UVM.

Join us on October 4 for a free panel discussion titled “The State of Opioid Addiction in Vermont: Treatment & Research,” part of Community Medical School at the Larner College of Medicine at UVM. The panel will feature Stephen Leffler, MD, Chief Medical Officer, Charles MacLean, MD, and Patricia Fisher, MD. The event takes place at 6:00-7:30pm at the UVM Given Medical Building – Carpenter Auditorium,  89 Beaumont Avenue, Burlington, VT 05405. Plenty of free parking is available. For more information call 802.847.2886.

It is hard to turn on the news or read the paper without finding stories about the epidemic of opioid prescription drug and heroin abuse. Opioid addiction and dependence have devastating effects on members of our communities and their families, and also put tremendous strain on our medical, social services, mental health, and criminal justice systems.

A Focus on Opioid Addiction Prevention

While much of the focus has been on the downstream consequences of substance abuse and the expansion of treatment programs, it is important to also emphasize the upstream or preventive side of the equation in order to achieve progress. For example, it is well known that the path to heroin abuse, for most users, starts with misuse of prescription opioids, so developing strategies to decrease the diversion of prescription opioids could have a positive impace.

Monitoring Opioid Prescriptions

Monitoring of opioid prescribing is a responsibility that is shared by federal and state public health and public safety professionals, working in collaboration with prescribers and communities. All states except one now have central “prescription drug monitoring programs,” which record all controlled substance prescriptions and help eliminate activities such as “doctor-shopping” and unethical “pill-mill” clinics.

In Vermont, we are fortunate to have had relatively little of these types of diversion compared to other states. The most recent report from the Vermont Prescription Monitoring Service (VPMS) shows – for the first time since its inception in 2009 – a decrease in the amount of opioids prescribed in Vermont.

This summer, the Centers for Disease Control published a new guidelines for clinicians regarding the safe and effective approach to the use of opioids for chronic non-cancer related pain. These guidelines emphasize the use of non-opioid approaches to managing chronic pain, a stricter level of monitoring, and an ongoing conversation with the patient regarding the potential benefits and risk of treatment. My favorite educational video summarizing the risks and benefits of opioids is produced by Dr. Mike Evans from the University of Toronto, who we invited to give a lecture at the University of Vermont earlier this year. (Note: This video is 11 minutes long and somewhat detailed, so it make take several viewings to get it all.) In my opinion, it is a must-see for anyone considering long-term opioid treatment.

Decreasing Opioids in the Emergency Room

Our colleagues in the Emergency Department have been successful over the last decade in decreasing the use of opioids unless absolutely necessary.

Various groups of researchers at the Larner College of Medicine at UVM are working on projects to help us find the right balance between over- and under-prescribing opioids. For example, I am leading a project now to determine the “right” amount of medication to prescribe after an operation. Too often, I have heard a friend say, “When I had a recent operation, I was given thirty oxycodone, but I only ended up using two.” We are working with surgeons, pain specialists and, most importantly, calling patients a week after surgery to find what the “right” prescription should be.

The Role of Our Community

Finally, perhaps the most effective strategy to decrease opioid use is one that is not often recognized – the role of each of us as community members to recognize the dangers in having potentially divertible prescription medication in our communities. I heard last week from a colleague in oral surgery who said that parents of children having their wisdom teeth out are increasingly asking for a post-op plan that does not involve opioids at all.

Charles MacLean, MD, is a primary care internal medicine physician at the UVM Medical Center and associate dean for primary care and professor at the Larner College of Medicine at UVM.

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