Finding relief from the pain of addiction

If opioid addiction were a cancer in the body of the U.S., today it would be at Stage 4, metastasized and spreading throughout every corner of every state.

In my rural North Carolina family practice clinic, I am keenly aware of opioid misuse and addiction. I regularly see patients struggling with addiction or I hear their stories of loved ones stuck in its clutches. 

{mosads}No one sets out to become an addict. The paths to addiction are many and it is a healthcare provider’s responsibility to mitigate them.

Many of my patients suffer with chronic, sometimes debilitating, pain for which they are seeking relief. As providers, we must acknowledge the reality of the situation. We need to challenge the belief there is a “quick fix” to pain management. And we must be willing to roll up our sleeves and dig into the root cause of our patient’s pain, working as their partners and advocates to develop a treatment plan that considers alternatives to opioids for pain management, but that also leaves opioids as an available option if truly warranted. Decisions regarding therapeutic options and management for pain should be determined using best practices and evidence-based guidelines on a case-by-case basis.

Over the last several months, all corners of this country and all levels of government have raised the alarm about the opioid addiction crisis and called for tools to address it. This is good news for patients. But key members of the solution team – PAs (physician assistants) – are too often left out of the discussion. We need all providers engaged in this fight to successfully end this epidemic, particularly in light of the current shortage of providers specializing in addiction medicine.

PAs have a critical — yet often understated — role in opioid treatment.

There are approximately 30,000 PAs practicing as primary care providers on the “front lines” of patient care in hospitals, private practices, community health centers, rural health clinics, prisons, behavioral healthcare facilities, and free clinics, where they commonly encounter patients who present with or are at risk of opioid addiction. This care is especially critical in rural and medically-underserved areas, like at my practice, where PAs may serve as the only primary care clinician for the community.

Medication assisted treatment (MAT), used in conjunction with traditional therapies, is a proven solution for patients suffering from opioid addiction. PAs have a direct connection to patients and are part of MAT programs. Yet, PAs are prohibited from prescribing one of the most useful MAT drugs for the treatment of opioid addiction – buprenorphine, a Schedule III drug that PAs may already prescribe for pain management purposes.

The need for treatment consistently outstrips capacity for treatment in every state. In 2012, an estimated 2.3 million Americans either abused or were dependent on opioids. But treatment programs offering MAT only had capacity for 1.4 million – leaving hundreds of thousands of Americans without access to all of the tools available in the fight against opioid addiction. 

The solution starts with PAs. But it requires immediate changes to federal law to enable PAs to prescribe buprenorphine for opioid addiction. 

Legislation recently passed through the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) — S. 1455, the TREAT Act — would remove this barrier for PAs. It is important for the House of Representatives to also provide PAs with the ability to prescribe buprenorphine for opioid addiction as one of many tools needed in this fight.

The diverse and high level discussions regarding pain management and addiction treatment over the last few months have been an encouraging sign that we are on the cusp of turning the corner in this crisis. All parties appear to agree that we need to stop opioid addiction before it occurs through the use of safe prescribing practices, patient monitoring and screening for potential abuse. Now, they need to ensure that the proposed solutions enable all healthcare providers to play their part in making a difference for those already struggling with dependency.

Jeffrey A. Katz, PA-C, DFAAPA, is a PA working in a family practice clinic in rural Taylorsville, NC; and is president and chair of the board of the American Academy of PAs.