There is serious shortage of effective medical help for patients with complex chronic pain and substance
use disorders. Patients addicted to pain pills or other opiates often lack access to effective medical care. There is an epidemic of opiate misuse. It could be argued that opiate related problems are one of America's primary public health concerns. What to do?
The first step generally involves doing what you can to help yourself or a loved one. Afterwards, we can attempt to heal others and the community at large.
With the closure of the Seattle Pain Clinics in 2016 the shortage of practitioners has been heightened. The Department of Health published a flyer to help patients out: https://wsma.org/doc_library/Education/Opioid/SPC_Patient_Resources_from_DOH_2016.pdf
It provides links to helpful resources including suicide hot lines.
For yourself or a loved one:
1. Obtain a formal pain management or addiction medicine consult.
These are unfortunately difficult to come by. Ask your doctor for suggestions or referrals.
Call the confidential Washington approved hotline: 1-866-789-1511
The website is: http://www.warecoveryhelpline.org/
To get a referral for evaluation for a substance use disorder is indicated if not already done. Unfortunately most physicians are ill prepared to do a formal substance use disorder assessment. Conversely, most state authorized/licensed chemical dependency services are ill prepared to address co-morbid pain management or mental health problems. Given the importance of Medication Assisted Treatment (MAT) in all patients with opioid use disorders, and the proven value of same in other substance use disorders, medical support is often essential for the best outcomes for those with substance use disorders. To have a formal diagnosis of a substance use disorder clearly changes what constitutes the best care. Hence, to have a substance use disorder formally ruled out is indicated for most patients with chronic pain management issues. If a substance use disorder is present referral for care can also be obtained.
There are many ways a pain management and an addiction medicine specialist can help patients:
- Work with other prescribers to assure that a patient is prescribed the safest and most effective medical regimen.
Provide FDA approved medical care for addictions. Besides buprenorphine, naltrexone is another FDA approved medication that can be helpful for treating opiate addiction and alcohol use disorders. It is also useful in some cases of chronic pain.
- There are non-pharmacological ways to manage pain and addictions. Since the early 1980s Dr. Rotchford has provided medical acupuncture. He is skilled in a host of ways to treat pain that do not include addictive substances.
- There are a host of medications, supplements, and behaviors that promote healthy pain management and brain function. The best care is individualized.
2. Seek help whether through OPAS or others:
- List of pr
- Worth checking out but I am afraid many patients struggle to find qualified providers particularly if they are insured by Washington State plan. Help us if you can keep this list updated.
- Methadone/Buprenorphine Clinics in Puget Sound Area
- These are the default care providers for patients who are opiate dependent. Access is challenging, sometimes expensive, and makes it difficult to hold down a job if one lives or works far from one. Nonetheless, when one has a life threatening disease, such as opiate addiction, a move to a community which has a methadone clinic warrants serious consideration.
- Special information for patients with Washington State Insurance plans including DSHS, Apple Health, Basic Health, L&I. See Memo
Community wide action steps and support material:
- This is an academic article submitted for publication. It makes the point that a good percentage of pain patients, particularly high risk patients, are at risk for having a formal opioid use disorder if they have been prescribed opioids over an extended time. The lack of appreciation for this is significant within the medical community.
- The Inhumane and Dangerous Game of Forced Opioid Reduction
This is an editorial by a respected pain specialist that lays out some of the issues that have come up with the current opioid phobia and untoward effects of regulatory efforts to curb opiate use. While risks are significant without proper patient selection and oversight, there remains an unequivocal place for the proper chronic use of opiates in medicine.
Please let us know other ways you have found helpful in finding effective medical care for your condition(s).
We support interested family members, parents, friends, and others to come together to help create a political force that would encourage state policy makers to effectively address the medical needs of patients with complex chronic pain or substance use disorders. If you are interested in such a group our office has started to put together a list of interested persons. Without grass root's political pressure it is unlikely the lack of access will effectively change.
- Our local Hospital Board/Commission meetings might be a place to clamor for access to effective medical care for pain and addiction.