- Catherine Shafts, DO and Mort Glasser, MD
As a Federally Qualified Health Center in northeastern Connecticut, our mission is to improve the health of the towns we serve. In 2007, we were known as a place where one could easily get prescription opioids. At the same time, opioid abuse, addiction and overdoses were being recognized as a national epidemic. We decided to make a change. All chronic pain management plans were reviewed. Medications were not benefiting patients and often being diverted. This led to a complete reversal of prescribing practices and overhaul of how we managed chronic pain.
We decided to stop prescribing opioids for chronic pain management. All patients were reassessed and alternatives were chosen to manage pain. It was difficult at first. Patients complained to the medical staff, administration, chief medical officer, and Department of Public Health that their needs were not being met. Everyone realized we were not abandoning our patients but rather offering better, healthier treatments. Our efforts were supported.
Since much of our population is transient, including homeless persons, migrant farm workers, former prisoners, and patients with mental health and substance abuse disorders, we wanted a system in place that did not discriminate based on appearance or history. The policy is the same for a 70-year-old woman with osteoarthritis as a 35-year-old man with chronic low back pain.
Patients were offered help at addiction treatment centers, referred to pain management, and given non-addictive options to treat pain. It led to a cultural shift. In time, we experienced less staff stress, fewer irate phone calls, and fewer calls to police. A variety of patients began to come to the community health center instead of only those desiring opiates. Newborns, seniors and families began seeking care. Our child patient population increased significantly. We became a true Family Medicine practice.
Many patients ultimately have been thankful for the changes. So many negative stories started with “A doctor prescribed these medications, so I thought they were okay.” Going forward, prevention, identifying those at risk, and asking questions about abuse is our focus. Each patient is screened for substance abuse. ACE (Adverse Childhood Experience) scores are being used and discussed. Consistently addressing opioids with preteen and teen patients to prevent use is paramount. With this policy and these new practices, we hope to continue to impact opioid abuse and overdoses and make our small part of the world healthier.