Dr. Tom Higgins gives us his perspective. We ask him if there is still a use for them, if you should say no if your physician recommends them or be concerned if someone you love is using them, and what he thinks needs to be done.">

May 10, 2016 — Opioid-based prescription pain medications are the third leading cause of death for Utah adults under 65 years of age. Given their dangers, should physicians continue to prescribe opioid pain medications? Orthopedic trauma surgeon Dr. Tom Higgins gives us his perspective. We ask him if there is still a use for them, if you should say no if your physician recommends them or be concerned if someone you love is using them, and what he thinks needs to be done.

Interview

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Interviewer: Dr. Higgins, so when it comes to opioid pain pills, I'm getting the point personally, and I want to see how you would react to this with the physician perspective, that opioid pain medications, they're just really bad news and we really shouldn't have them in our medicine cabinets anymore. We really should look for other ways to treat pain because you continue to hear about deaths and overdoses and addictions. Am I being a little overstated on that?

Dr. Higgins: Yes and no.

Interviewer: Okay.
Dr. Higgins: There are certainly indications and uses for opioid pain medicines, where appropriate. And the presence of them in your medicine cabinet, by themselves, is not harmful. It is the chronicity of use, using them over a longer period of time, and ramping up the doses, which is, and this is proven in the literature, this is where people get in trouble.

Interview: What should we do about what seems to be going on? It seems almost like a national health epidemic. And there again, I may be overstating this.

Dr. Higgins: It's absolutely not overstating it. It is a national health epidemic. If you set aside cancer and heart disease, the thing that was most likely to kill an American under 65 was their car with some sort of motor vehicle accident. It was that way for some time. In 2003, it was the first year in the state of Utah where a prescription opiate was more than likely to lead your demise than a motor vehicle wreck. That was kind of revolutionary at the time. Now, it's that way in greater than half the states.

Interviewer: Okay. So we were kind of ahead of the curve.

Dr. Higgins: Yeah, it's nothing to be proud of.

Interviewer: Yeah, in a bad way, yeah. So it is something that we need to address. As a patient, if my doctor says, "I'm going to prescribe you some pain medication that's opioid-based," should I say, "I'd rather look for a different solution?"

Dr. Higgins: If you want to do that, your doctor should definitely respond. The old teaching was that as long as you had discomfort, the opioids [Audio skips 00:02:12] likely to be taking someone else's medicines. The people in the 40 to 60 age group are more likely to be taking their own medicine and they were on it chronically and they were on higher doses. And there are people here doing some pretty fascinating research on what the susceptibilities are. We may all have genetic susceptibilities to flip that switch. So even if you don't think you have "an addictive personality," then you can certainly develop one rapidly even if you don't think it's in you.
The other thing is to not necessarily judge those people that have had problems. Plenty of very prominent people and people who we wouldn't necessarily expect have certainly run into problems and, in some cases, have been fatal.

Interviewer: So at the end of the day, a physician perspective, what do we do to solve the problem?

Dr. Higgins: I think it's critically important of late that the public becomes aware and this happens through the lay press. And then, from a physician standpoint, we have to educate the patient at the beginning, the initiation of treatment. Secondly, have an exit strategy. Thirdly, entertain other modalities we can be using besides these medicines to treat the pain.

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