Monday, September 7, 2015

We are on Notice

Michael Gavin is a blogger at EvidenceBased and he is the President of Prium, a company that deals with medications. It is a thoughtful blog and worth a read. Unlike some of my missives, he keeps it short and to the point. It is an award-winning blog.

In May, he penned We Know too Much, a frank discussion about issues surrounding pain medication in general and the interrelationship it has with workers' compensation. Injuries are sometimes painful, that goes without saying. The pain may be sudden or delayed, sharp or dull, consistent or sporadic. In a nutshell, it does not come in a one-size-fits-all. To make it more difficult, we humans all have our own ways of perceiving and responding to pain.

I went to a program several years ago. The speaker said that pain is not a sensation, but an emotion. He explained that the same portions of the human brain that deal with emotions deal with pain. Having captured our attention, he then conceded that pain may not in fact be an emotion per se, but he persisted that the two are related. He also said that pain is different for each individual. It was interesting. During his presentation, I cracked my knee on that strange-shaped metal bracket under folding tables (that keeps the legs from folding during use). I had a profound "emotional" reaction to that stimuli.

Mr. Gavin has taken the bull by the horns in his May note, We Know too Much. He says that pain medication containing opium (called "opiods"), are not good for people. He describes how they became introduced into the lexicon of modern medicine and the damage that they do. I have previously written about the potential for harm from opiods. It continues to astound me that modern Americans are statistically more likely to die from prescription medication than from an automobile accident. 

Point one to Mr. Gavin, these compound are potentially dangerous and potentially lethal. This could be the end of the discussion perhaps; except that there are people who have pain and opiods have become a "go to" for the physicians who treat traumatic injury/damage, and our resulting perceptions of pain.

He concedes that decreasing the volume of opiods in our system will not be easy. People are accustomed to these medications. Some patients have been taking them for many years. The pills have become the way in which they deal with the pain. Any professional will become accustomed to certain tools. Too often opiods are the "go to" familiar tool for physicians. Will there be discussions of what other potential tools may be in the physician's line-up as alternatives to opiods?

Mr. Gavin's primary point seems to be financial though. He notes that some states are holding employers and carriers responsible for workers' compensation death benefits when pain medication overdose occurs. It is unfortunate that it is this financial cost that forms the foundation for the change argument. He points out that the workers' compensation industry's "unwillingness . . . to apply what we know is going to cause a lot of financial pain over the next several years." While that is notable, it would seem that the deaths themselves, the human cost, would be enough encouragement?

It seems like there are two problems that are worthy of discussion. After the column appeared on Mr. Gavin's blog, it was reprinted by WorkCompCentral. That rendition drew a comment by a user nicknamed "lie detector," that is also worth reading. The commenter notes that there are people who need pain relief and need to quit taking these medications. What alternatives are they offered for the relief from, or coping with, this pain? That discussion is worthy of attention.

Another focus can perhaps be the cost-savings suggested by Mr. Gavin. A generalized cost/benefit analysis may drive the debate, but at the end of the analysis might the marketplace end up where the commenter suggests it start? That is, are there alternatives for the treatment of pain? Alternatives that do not present the potential addicting qualities of opiods, the potential overdose risks, the societal and personal costs to the patient and families?

In short, there may be justification for slowing the flow of opiods into the recovering worker market. But, it may seem hard for some to accept that the solution to opiods is simply stopping the flow/availability. The key point is that the human being may need some mechanism or modality to alleviate or deal with the pain. It would be a great benefit to that human being if the modality was not potentially damaging or life-threatening in itself. 

Workers' compensation is on notice as Mr. Gavin suggests. Now the question is not whether we need to do better. The volume of death is simply not acceptable. The question is how we do better, and when will we get to it? 

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