Wisconsin's dose of reality: Prescription opioid abuse reaches epidemic proportions

Milwaukee Medical Society to play key role in attorney general’s “Dose of Reality” campaign to stop a deadly trend

The Medical Society of Milwaukee County (MSMC) is joining Wisconsin Attorney General (AG) Brad Schimel — along with other health care provider organizations, municipal government leaders and law enforcement agencies — to kick off a major public awareness and prevention campaign aimed at educating Wisconsin communities about the dangers of prescription painkiller abuse.

The MSMC’s involvement in the AG’s campaign, launching September 17th, stems from the Society’s newly rebranded mission — “Powered by Physicians, Compelled by Community” — to be a driving force behind efforts to improve the lives of the people of Greater Milwaukee. 

The Attorney General’s campaign was launched at a news conference September 17th at the Milwaukee County Medical Examiner’s Office.  Dr. Brian Peterson, chief medical examiner and president-elect MSMC opened the news conference for Attorney General Schimel.  Also speaking were Kitty Rhoades, Secretary, Wisconsin Department of Health Services; John Nygren, State Representative; and, Dr. Andy Anderson, Executive VP and Chief Medical Officer, Aurora Health Care.

“There is so much information to share – and misinformation to clear up – surrounding this issue, which I discovered as I traveled the sate over the past year talking about the heroin epidemic,” Schimel said. “This is a message of hope and prevention.  We can win this battle and make our state safer and healthier.”

The need to address the opioid abuse problem was brought to the MSMC board’s attention by Dr. Peterson who deals with the all-too-often tragic end result of prescription drug addictions. It’s not unusual for Peterson’s office to handle four cases per day of people who have died from drug overdoses; over 150 deaths have been attributed to drug overdose in Milwaukee County in the first half of 2015.

And the problem is only expected to get worse. Dr. Peterson has estimated that if current trends continue, “Overdoses will account for some 20% of our autopsies this year, compared to 10% motor vehicle accidents, less than 3% for infant deaths, and around 15% for homicides.”

“The prescription drug abuse problem has been become an epidemic,” says MSMC Executive Director Kathy Schmitz, who recently represented Wisconsin as one of six states selected to participate in the National Governor’s Association’s (NGA) Policy Academy on Reducing Prescription Drug Abuse. The participating states were charged with developing and implementing comprehensive and coordinated strategies to combat the “abuse and diversion” of prescription drugs, while maintaining access to the drugs for patients with a legitimate medical need.

But the epidemic is not just Milwaukee County’s problem. Prescription drug abuse is now a major crisis for communities all across the state, and the nation. According to Schimel, the number of accidental opiate overdose deaths in Wisconsin has more than quadrupled in just the past decade. So has the number of emergency department visits for opiate poisonings.

Schimel’s statewide campaign, “Dose of Reality: Prevent Prescription Painkiller Abuse in Wisconsin,” will aim to create awareness about the dangers of using prescription painkillers (opioids) for nonmedical purposes; educate the general public about the need to keep prescription painkillers out of the hands of those who may abuse them; warn about the dangers of inadequate storage of such drugs; and inform targeted audiences about the role they play in education and abuse prevention.

The campaign’s primary target audience will be those who are most at-risk of misusing prescription painkillers: young adults between 18 and 24 years of age, and teens between 12 and 17. Adults over 25 years old, as well as influencers, parents, teachers and the medical community will be among the campaign’s secondary audience.

Schmitz, who served on a core team of leaders that functioned as liaisons between the NGA and Wisconsin health care and treatment providers, says MSMC’s aim is to use the campaign as a starting point for conversations in the community — among physicians and between physician and patient — about the dangers of prescription drug abuse, risk of addiction, and the proper storage and disposal of such drugs. She also envisions the campaign will inform the public about the importance of talking to their doctors about when — or if — such medications are really necessary for their medical conditions.

“We want to be part of the solution,” says Schmitz.  “Physician leadership is critical in our efforts to stop prescription drug abuse, and consumer expectations need to change.  Patients should consider asking whether they really need the opiate or prescription drug.  Is there an alternative drug that is non-addictive?   We can help be a source for that awareness and education, even if it is as simple as reminding patients to lock up their prescription drugs and dispose of them properly.”

Multiple factors led to a crisis

How did Wisconsin and the rest of the nation get to this point of crisis? It’s one that evolved over the past two to three decades, driven by health-care industry changes and cultural trends. Nationally, prescription drugs are the cause of 60 percent of all drug-overdose deaths; pain relievers such as oxycodone, hydrocodone and methadone are involved in three of every four prescription-drug overdose deaths, according to an NGA position paper.

“One thing is that prescribing trends have changed,” says Dr. Peterson. “When I was in medical school, doing three years in clinical medicine back in the early 1980s, narcotics were for hospitalized patients: people in post-op, people with cancer, people in the last stages of life. We weren’t prescribing (narcotics) for chronic pain.”

But these days, the amount of narcotics being prescribed for chronic pain is “astonishing,” he says.

According to Dr. Michael McNett, a chronic pain specialist and member of MSMC and the Wisconsin Medical Society, the push toward more effective pain management began to gain traction about the same time the pharmaceutical industry was promoting narcotics as the best way to manage pain. Although many doctors continue to believe that, there has been no medical evidence that opioid therapy works to manage chronic pain, according to Dr. McNett. However, evidence of the adverse effects of long-term use of prescription opioid use “is immense,” he says.

And yet, many patients still want prescriptions for those drugs because they associate the pleasure they get from them with pain relief, says Dr. McNett. When he moved to Wisconsin from Chicago in 2011, he was “shocked” at the extent of inappropriate opiate use in this state.

“And the explosion in heroin addiction is a maturation of the addiction process that gets started with prescription drugs,” McNett says.

When it comes to tackling the epidemic in Wisconsin, the attorney general’s campaign won’t be popular or easy. For one thing, doctors who stop prescribing opioids to patients who want them “tend to get a lot of pushback” from those patients, says Schmitz. 

However, that pushback is usually a sign that the patient has a prescription-drug problem, McNett says.

Which is why the MSMC’s role in the AG’s public awareness campaign will involve further educating doctors — not only about the epidemic, but also how to have conversations with patients about why a prescription for a drug such as oxycodone may not be in patients’ best interests.

“My goal with the physician community is to help them understand the risk-benefit ratio associated with chronic narcotic use, and to help them build appropriate expectations with their patients,” explains Dr. McNett. “If a patient has surgery and expects to be in pain for some time afterward, let the patient know in advance that he/she will get some medication, but that after a period of time we will have to take him/her off the narcotics and switch to other medicines that will help with the pain.”

McNett also wants to help inform physicians on the non-narcotic medicines available for long-term pain treatment, how to determine if a patient is running into trouble with narcotics, why it’s critical to catch those signs early, and how to get trained and certified in the use of Suboxone (buprenorphine) as an opioid addiction treatment. (McNett has such certification.)

“The more an addiction is fed, the stronger it gets,” McNett says. “The worse thing we can do is to continue giving that patient narcotics.”

MSMC President Dr. Marlene Melzer-Lange envisions the campaign as an opportunity to alert physicians about the need for “a careful balance” in the use of opioids for treatment of pain. She would like to see the MSMC share best practices for opioid prescribing and options for the proper disposal of such medications.

Preparing for the worst

Schmitz and Drs. Peterson and McNett acknowledge the state’s prescription-drug abuse problem will get worse before it gets better. Other states that have pursued similar prevention initiatives saw a spike in “doctor shopping,” on-the-street sales of prescription painkillers and heroin overdose deaths.

“Unfortunately, that’s one of the horrible consequences of having to launch such a dramatic initiative. We have to start somewhere, and we’re proud to support the Attorney Generals’ campaign, partner with such outstanding health care organizations and be a key resource to address this problem,” says Schmitz.

Dr. Peterson believes the campaign also will prompt a surge in patients seeking treatment for drug addictions. Treatment systems may be overwhelmed for a while, but Wisconsin communities will be healthier in the long run.

“We got into this problem slowly and it will take us a while to get out of it,” he says.

For more information on the Attorney General’s campaign, visit www.DoseOfRealityWI.gov

Medical Society of Milwaukee County
P.O. Box 13114, Milwaukee, WI 53213
Phone: (414) 475-4750

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