Posts Tagged pain

Attention Primary Care Providers: Alcohol and Drug Conference is March 19-21

Attention Primary Care Providers: Alcohol and Drug Conference is March 19-21


See also: Are You Interested in Becoming a DATA-Waived Physician?

Alabama Department of Mental Health has partnered with the Alabama Department of Public Health on a grant to increase awareness of substance use disorders among primary care professionals. This grant will allow ADMH to pay the registration fee only for any of the following to attend the Alabama School of Alcohol and Other Drug Studies (ASADS):

  • MD
  • DO
  • PA
  • CRNP
  • CNM
  • RN

The Medical Foundation of Alabama designates this live activity for a maximum of 27 AMA PRA Category 1 Credit(s)™.

ASADS has been conducting conferences for over 43 years. Over the past couple of years, there has been a heavy emphasis in the community and at the state level to begin to develop a system of care that integrates primary care and substance abuse treatment. There are many great speakers at this year’s conference.

Dr. Alta DeRoo, M.D., FACOG, will present Medication Assisted Treatment (MAT) Waiver Training. This is required 8-hour training.

T4: Medication Assisted Treatment (MAT) Waiver Training

This course is designed for MDs, DOs, PAs and CRNPs who are interested in becoming a 2000 Data Waived physician. This class will be held from 8 a.m. – 5 p.m. to meet the 8-hour requirement.

Course Description:

This presentation is designed to train qualified physicians in dispensing or prescribing specifically approved Schedule III, IV and V narcotic medications for the treatment of opioid addiction in an office-based setting. The goal of this training is to acquire the knowledge and skills needed to provide optimal care to opioid use disorder patients by providing:

1) an overview of opioid use disorder,

2) the efficacy and safety of buprenorphine,

3) process of patient selection,

4) clinical use of buprenorphine,

5) nonpharmacological interventions,

6) medical psychiatric conditions in opioid use disorder patients, office procedures, and

7) special treatment population.

This eight-hour training, which will include eight separate modules and four case studies. Each of the speakers will be presenting for two hours. The remaining two hours are broken up over the four case studies. Designated by the DHHS, this training meets the eight-hour requirement and is designed for physicians to dispense buprenorphine in office practice for treatment of opioid use disorder. Participation in this training will provide physicians with a comprehensive overview of buprenorphine prescribing and its safe and effective use in an office-based setting. This training is designed for physicians and other primary care providers who are likely to treat opioid-dependent persons in their practice, such as those in family practice, general internal medicine, psychiatry, pediatrics, adolescent medicine specialists, and Opioid Treatment Programs.

Course Objectives:

After attending the course, a participant will be able to:

• review addiction treatment in office-based practices;

• discuss the pharmacological treatments of opioid use disorder;

• determine what medical record documentation must be followed;

• discuss the process of buprenorphine induction as well as stabilization and maintenance techniques;

• describe how to take a patient history and evaluation; and

• review safety concerns and drug interactions.

Dr. Merrill Norton, Ph.D., will be conducting a three-part series on The Pain of Pleasure: A Pharmacist’s Guide to Opioid Use Disorders for Prescribers and Other Healthcare Professionals.

Dr. Cardwell Nuckols, Ph.D.The Neurobiology of Addiction: The Addiction Process in Three Stages

Dr. Boyett, D.M.D., D.O., DFASAM, and Dr. Taylor, M.D., M.P.H., F.A.S.A.MThe Delivery of Office-Based Addiction Treatment (OBOT) in the 21st Century

ADMH can pay the registration fee only. To have your registration fee paid, complete the registration form and return it to Kathy House at no later than Feb. 24.


See also: Are You Interested in Becoming a DATA-Waived Physician?

Posted in: Education

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ProAssurance and Sure Med Compliance Join to Fight Opioid Crisis

ProAssurance and Sure Med Compliance Join to Fight Opioid Crisis

BIRMINGHAM ─ ProAssurance Corporation has announced an exclusive affiliation with Sure Med Compliance® (SMC) to promote the use of SMC’s Care Continuity Program® (CCP) in an effort to help combat the opioid epidemic in the United States.

ProAssurance-insured physicians will be eligible for discounted access to Sure Med’s Care Continuity Program

The CCP helps physicians and other health care providers develop and maintain responsible prescribing practices for opioids and other scheduled medications by equipping them with tools to verify patients suitable for opioid therapy, identify with significant risk factors, and closely monitor the effects of treatment over time.

“As an industry leader, we are acutely aware of the devastating effects of the opioid epidemic in this country. We are concerned about the epidemic’s professional liability implications for physicians and other healthcare providers, as well as its broader effects on the healthcare system in general. We are proud to affiliate with Sure Med Compliance to offer our insureds exclusive discounted access to this cutting-edge approach to patient safety and effective treatment, ” said Howard H. Friedman, president of ProAssurance’s Healthcare Professional Liability Group.

John Bowman, Sure Med Compliance’s Chief Executive Officer, emphasized the importance of the newly formed affiliation.

“Our Care Continuity Program provides a proven path toward optimal outcomes for patients whose treatment requires the use of opioids and other potentially addictive drugs,” Bowman said. “In turn, CCP helps physicians avoid potential liability issues, which has always been a focus of ProAssurance and why we are so excited about this affiliation. We are confident their national footprint will help Sure Med Compliance reach more physicians and assist more patients than ever before.”

Through this affiliation, ProAssurance insureds who meet certain eligibility requirements will have access to an exclusive 30-day free trial of the CCP. ProAssurance insureds who elect to continue using the Care Continuity Program will receive exclusive discounted rates. ProAssurance insureds may contact Sure Med Compliance to determine eligibility and initiate a 30-day free trial by visiting or calling (866) 517-2771.

“As a practicing pain management specialist, I have experienced firsthand the challenges physicians face in deciding to prescribe controlled substances. Using the Sure Med Compliance CCP in my practice has helped me ensure proper documentation and address potential issues before they occur,” said Sure Med Compliance’s Medical Director David Herrick, M.D., of Montgomery. Dr. Herrick is a past president of the Medical Association of the State of Alabama and a former member of the Alabama Board of Medical Examiners.

ProAssurance’s Chief Medical Officer Hayes V. Whiteside, M.D., encouraged physicians with ProAssurance to learn more about the CCP.

“Our commitment to provide our insureds with exclusive discounted access to the Sure Med Compliance CCP underscores ProAssurance’s commitment to ensure physicians and other health care providers are equipped with the risk management tools and services necessary to deal with the ever-changing realities of their chosen profession,” Dr. Whiteside said. “All ProAssurance insureds who regularly prescribe opioids, especially those who prescribe for chronic pain, are encouraged to engage Sure Med Compliance to learn more about how their Care Continuity Program can help them develop and maintain safe and responsible prescribing practices, which should lead to better outcomes for their patients.”

Posted in: Opioid

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Opioid Prescribing Still High and Varies Widely Throughout U.S.

Opioid Prescribing Still High and Varies Widely Throughout U.S.

Opioid prescribing in the United States peaked in 2010 and then decreased each year through 2015, but remains at high levels and varies from county to county in the U.S., according to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC).

Six times more opioids per resident were dispensed in 2015 in the highest-prescribing counties than in the lowest-prescribing counties. This wide variation suggests inconsistent prescribing practices among health care providers, and that patients receive different care depending on where they live.

“The amount of opioids prescribed in the U.S. is still too high, with too many opioid prescriptions for too many days at too high a dosage,” said Anne Schuchat, M.D., acting director of the Centers for Disease Control and Prevention. “Health care providers have an important role in offering safer and more effective pain management while reducing risks of opioid addiction and overdose.”

CDC researchers analyzed changes in annual prescribing measures from 2006 to 2015 and found that while there have been declines in opioids prescribed, more can be done to improve prescribing practices. For example, between 2006 and 2015 opioids prescribed peaked in 2010 at 782 morphine milligram equivalents (MME) per person and decreased to 640 MME in 2015. (MME is the amount of opioids in milligrams, accounting for differences in opioid drug type and strength.)

Daily MME per prescription remained stable from 2006 to 2010 and then decreased 17 percent from 2010 to 2015 (from 58 MME to 48). However, the average days’ supply per prescription increased 33 percent from 13 days in 2006 to almost 18 days in 2015. Opioids prescribed per capita in 2015 was still approximately three times as high as in 1999.

County-level opioid prescribing patterns vary

For this Vital Signs report, CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns for the years 2010 and 2015.

County-level factors associated with higher amounts of opioids prescribed include:

  • A greater percentage of non-Hispanic white residents.
  • A greater prevalence of diabetes and arthritis.
  • Micropolitan areas (non-metro small cities and big towns).
  • Higher unemployment.

“While some variation in opioid prescribing is expected and linked to factors such as the prevalence of painful conditions, differences in these characteristics explain only a fraction of the wide variation in opioid prescribing across the United States,” said Deborah Dowell, M.D., M.P.H., chief medical officer in the Division of Unintentional Injury Prevention at CDC’s National Center for Injury Prevention and Control. “This variation highlights the need for healthcare providers to consider evidence-based guidance when prescribing opioids.”

Ensuring access to safer, more effective pain treatment

In 2016, CDC published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. These recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than three months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care. The Guideline includes recommendations such as:

  • Use opioids only when benefits are likely to outweigh risks.
  • Start with the lowest effective dose of immediate-release opioids.
  • Reassess benefits and risks when considering dose increases.

Health care providers should also use state-based prescription drug monitoring programs (PDMPs), which help identify patients at risk of addiction or overdose.

The Guideline can also be used by health systems, states, and insurers to help ensure appropriate prescribing and improve care for all people. Tools and resources are available to help providers and patients discuss the risks and benefits of opioid therapy for chronic pain to improve the safety and effectiveness of pain treatment and to reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. For more information about preventing opioid overdose:

Vital Signs is a CDC report that typically appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report. The report provides the latest data and information on key health indicators, such as cancer prevention, obesity, tobacco use, motor vehicle injury prevention, prescription drug overdose, HIV/AIDS, alcohol use, health care-associated infections, cardiovascular health, teen pregnancy, and food safety.

For information about the Medical Association’s prescription drug abuse awareness program, visit Smart & Safe.

Posted in: Smart and Safe

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Opioids in Alabama: Where Do We Go From Here?

Opioids in Alabama: Where Do We Go From Here?

The numbers are staggering. In 2015 alone opioid-related overdoses accounted for more than 33,000 deaths — nearly as many as traffic fatalities. Today more than 2.5 million adults in the U.S. are struggling with addiction to opioid drugs, including prescription opioids and heroin.

According to the Centers for Disease Control and Prevention:

  • About 91 Americans die every day from an opioid overdose (that includes prescription opioids and heroin)
  • Drug overdose deaths and opioid-involved deaths continue to increase in the United States
  • The majority of drug overdose deaths — more than six out of 10 — involve an opioid
  • Since 1999, the number of overdose deaths involving opioids — including prescription opioids and heroin) quadrupled
  • From 2000 to 2015 more than half a million people died from drug overdoses
  • In 2014, almost 2 million Americans abused or were dependent on prescription opioids
  • Many people receiving prescription opioids long term in primary care settings struggle with addiction, ranging from 3 to 26 percent in a review by the CDC
  • Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids

How did we get here?

In 2015, among 52,404 drug overdose deaths, 33,091 were from opioids that physicians prescribe such as hydrocodone. Studies suggest most of these involve diversion of legally prescribed pills, but some people died of the pills prescribed to them. Increasingly, as officials from the CDC recently testified before Congress, it is illicit drugs such as heroin and fentanyl that account for a rising tide of deaths.

Tracing America’s opioid epidemic goes back some experts say to the Roaring Twenties – a time when flappers danced to hot jazz, bootleggers sold black market alcohol in speakeasies run by mobsters, and morphine was handily prescribed for anxiety and depression.

“Opioids have been around for a very long time. Even back in the 1920s if you had depression or anxiety and you went to the doctor, you were likely to be prescribed a morphine-like medication,” said Daniel Doleys, PhD, clinical psychologist, director and owner of The Doleys Clinic in Birmingham. “Narcotics and opioid compounds do tend to stabilize different psychiatric problems, so oftentimes when we are prescribing these to patients, we think we are treating pain, but we may inadvertently be treating these underlying problems. The significance being that the patient may not show much improvement in pain or functioning, resulting in a lowering of the dose. This, however, can lead to re-emergence of the psychiatric symptoms and a plea from the patient and family to restore the medicine to its previous level. The potential impact of opioids on psychiatric symptoms, such as anxiety, depression, bipolar disorder, PTSD, and how this relates to the prescribing and overuse of opioids has not gotten much attention.”

According to Dr. Doleys, the altruistic nature of medicine itself could be one of the primary factors involved in today’s opioid crisis. Physicians are trained in the healing arts and simply want to heal their patients.

“You cannot cure suffering, and that’s part of the problem. You have a lot of well-intended clinicians who feel their job is to cure suffering. But, you cannot cure all suffering,” Dr. Doleys explained. “A certain amount of suffering is not necessarily a bad thing. It motivates us; it drives us. In our attempt to try to cure suffering, we have become co-dependent with the patient and taken their problem and made it our problem. So, we’ve communicated with the patient that I have something here that I’m going to give you. We will start with two of these pills a day. It may or may not be enough, but we’ll see. The message to the patient may be, if two isn’t enough, we can increase the dose. The often unrecognized position assumed by the well-meaning doctor is that I’m committed to saving this patient from suffering, and if this patient is still suffering, then I need to keep going until I find a cure.”

More emphasis needs to be placed on clarifying expectations, goals and patient responsibilities as it relates to their treatment. All too often patients are allowed to become ‘passive recipients rather than active participants’ in their treatment, according to Dr. Doleys.

What is so special about opioids?

In 1986, pain specialists Russell K. Portenoy and Kathleen M. Foley published “Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases” in the journal Pain.

“We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse,” the authors wrote.

Dr. Doleys said of the study that with 67 percent of patients reporting a fairly good outcome with little adverse effects, although at doses much smaller than we typically see today. The study became “the lightbulb” that began a trend for opioids, which were originally prescribed only for malignant pain, to be used with other types of chronic pain.

“Questions soon began about how our bodies have these receptors which we already know will react to specific medications. We have these medications, but we are not helping people who are suffering and dying with pain,” Dr. Doleys said. “There was an increased awareness of people in pain from other sources rather than cancer, and the concerns began to grow about the under-treatment of pain, and some concerns were valid and almost criminal.”

In the 1980s, physicians began facing mounting pressures from not only their patients who were suffering from chronic pain issues, but also from advocacy groups and the federal government over the under-treatment of pain as a serious medical issue. By this time, there were about 100 million Americans reportedly suffering from chronic pain-related issues, according to the Institute of Medicine. With advertisements blasting away on television further advocating for the treatment of pain and applying even more pressure to the medical community to aggressively treat chronic pain, physicians were caught in the middle.

Pharmaceutical companies saw an opportunity and began producing more and more opioid medications, touting these new medications to physicians and federal regulatory boards as being safer than other painkillers on the market at that time. Unfortunately, this was not the case. When the dust settled and some of these companies were brought to court over their false advertising claims, millions of patients were addicted to their products.

Where the pendulum of prescribing opioids once swung toward over-treating chronic pain issues is now swinging back in a new direction, new issues are being uncovered – specifically addiction.

How opioids kickstarted the national conversation of addiction

“There is one positive outcome of the opioid epidemic. It has raised the awareness and acknowledgment that addiction is a disease. A national conversation has been initiated as a result of the severity, morbidity and mortality associated with opioid misuse and addiction,” explained addiction medicine specialist James Harrow, M.D., PhD. “We have been reluctant to acknowledge that addiction is a chronic, primary brain disease as opposed to what many people still believe is a voluntary process and that sufferers can just stop. That’s not the way it works. It is a biopsychosocial-spiritual disease that is chronic, relapsing and potentially lethal.”

According to Dr. Harrow, addiction is no different than other chronic diseases such as diabetes, asthma or hypertension. Addiction is preventable and when a patient has the illness, it is treatable with resultant long-term abstinence and remission. Those who are affected will be at risk of relapse to their drug of choice or other substances including alcohol for their lifetime. One of the problems we encounter is that addiction medicine is not taught in medical school.

“Medical education provides little to no training for what is probably the most prevalent disease in our nation today,” Dr. Harrow said. “The teaching of addiction is beginning to develop gradually within medical schools. However, if we do not educate medical students early in their training, then it is more difficult to assimilate the understanding of the disease when they enter practice.”

As with any other disease, physicians are not immune to the disease of addiction. Looking at the national population of physicians in the United States, roughly 900,000 doctors, the lifetime prevalence of addiction of practicing physicians is around 15 percent or about 135,000, Dr. Harrow said.

“Physicians may see themselves as superhuman, but that’s not the case. They may not be able to see themselves as being able to have these diseases, but they can and do,” Dr. Harrow said.

Because physicians face the same diseases as the patients, including addiction, that’s where the Alabama Physician Health Program steps in. APHP was created by the Alabama Legislature as a means for the Alabama Board of Medical Examiners and the Medical Association to address problems such as chemical dependence or abuse, mental illness, personality disorders, disruptive behaviors, sexual boundaries, etc. All information is privileged and confidential. The success rate of APHP for five years of monitoring is 85-90 percent with physicians successfully returning back to practice versus the long-term success rate of other programs of about 60 percent.

A clinical tool to aid in the war on opioid abuse

The Prescription Drug Monitoring Program is housed in the Alabama Department of Public Health and developed to detect diversion, abuse and misuse of prescription medications classified as controlled substances under the Alabama Uniform Controlled Substances Act. Under the Code of Alabama, 1975, § 20-2-210, et.seq, ADPH was authorized to establish, create and maintain a controlled substances prescription database program. This law requires anyone who dispenses Class II, III, IV and V controlled substances to report the dispensing of these drugs to the database.

Mandatory reporting began April 1, 2006. For those physicians who are eligible to use the PDMP, but are not yet registered, access is easy. Registering to access the PDMP database can be done by:

  • Go to
  • Click on PDMP Login found in the orange menu banner on the left
  • Click on Practitioner/Pharmacist
  • Click on Registration Site for New Account
  • Enter newacct for the User Name and welcome for the Password
  • Complete the registration form and click on Accept and Submit

You will receive two emails when your application is approved; one with your user name and a second with a temporary password. Each physician can designate two delegate users per office. These delegate users have their own usernames and passwords to access the PDMP system.

If you have trouble using the PDMP, help is at your fingertips. Assistance with passwords, connection issues, search and query issues, and most other PDMP problems is just a phone call away at (855) 925-4767 and follow the prompts or by email at

The Alabama PDMP anticipates switching to new software later this year. The new software is user-friendly and has additional features that will aid prescribers and dispensers in making the best clinical decisions for their patients. More information about training will be emailed to users in the coming months.

Where do we go from here?

It would seem there’s a story on the news every day about opioid abuse. A new statistic, a new arrest, a new death toll, yet no new solutions even though every state and every organization has a task force or study group working on the nation’s epidemic.

Stefan Kertesz, M.D., MSc, is associate professor at the University of Alabama-Birmingham School of Medicine and director of the Homeless Patient-Aligned Care Team at the Birmingham Veterans Affairs Medical Center. His 20-year career has combined research and clinical care focused on primary and addiction care of vulnerable populations with funding from the National Institute on Drug Abuse and the U.S. Department of Veterans Affairs. In 2016, he provided peer-reviewed and public media reviews of several facets of the opioid crisis, the rise of illicit fentanyl and heroin deaths, and how new policies affect patients with pain conditions. He may not have any new solutions, but his close study of the opioid epidemic has uncovered some interesting insights.

“We as doctors played a significant role in developing the opioid market, even though at this point we’re not the ones sustaining it,” Dr. Kertesz said.

In fact, one of Dr. Kertesz’s chief concerns stems from the revised CDC Guideline for Prescribing Opioids for Chronic Pain, issued in March 2016, which might have caused a “pendulum swing” from the status quo of prescribing of opioids for chronic pain to a stricter guideline for their use. The CDC Guideline provides recommendations for primary care physicians who are prescribing opioids for chronic pain outside cancer treatment, palliative care and end-of-life care. This pendulum swing toward an effort to curb prescribing habits might be putting more patients at risk than physicians might know.

“As physicians today execute a hard shift on opioids, I plead for caution,” Dr. Kertesz said. “Patients with chronic pain have reported enormous suffering, some committing suicide as they see their lives turned upside down by doctors pressured to reduce their medications. Opioid prescribing ran up even more because of the use of the pain score…a subjective single number. Now there is an emergence of academic physicians who have dedicated their work to fighting addiction, including some who even worked on the CDC Guideline. They see that clinical practice has sprung ahead of data, that it has begun to look like someone has shouted fire in a crowded theater, creating a social stampede. This does not reflect the cautious, patient-centered care urged by the CDC.”

Dr. Kertesz is not advocating a return to the old days of prescribing opioids. Far from it. He works in Jefferson County, one of Alabama’s hardest hit counties where deaths by heroin, fentanyl and other prescription medications are disturbingly high. In fact, he’s doing everything he can, short of shouting from the rooftops, to inform government officials and colleagues about changing the opioid epidemic. He’s written opinions and reports for STATNews, Pain News Network, Huffington Post, and Politico. He’s given interviews for state and national news agencies. He’s published numerous peer-reviewed papers and articles. And, earlier this year, he issued a briefing for Surgeon General Vivek Murthy. The message should be clear: We need a better message.

“Saying that opioids are just as addictive as heroin is fantasy, the same as solving opioid overdoses in doctors’ offices alone when most individuals with opioid addiction did not start out as pain patients,” Dr. Kertesz explained. “When Surgeon General Dr. Vivek Murthy made an under-appreciated declaration that we cannot allow the pendulum to swing to the other extreme here, where we deny people who need opioid medications those actual medications, as an addiction professional, I agree.”

How the Medical Association continues to be a leader in the fight against Alabama’s prescription drug abuse epidemic

In Alabama, our situation is equally staggering. According to the Alabama Department of Public Health, 762 Alabama residents died between 2010 and 2014 due to drug overdose, which included prescription drug overdose. In 2014 alone, there were 221 deaths due to drug overdoses.

“A group of us from the Medical Association met with some DEA officials and sheriffs who told us that Alabama was number one for hydrocodone until 2001,” said Association President Jerry Harrison. “We fell out of the top slot for a few years, but we got it back. We recognized that Alabama was in a very bad place, and we knew we had to take action.”

The Medical Association helped pass legislation in 2013 to reduce prescription drug abuse and diversion. That legislation resulted in Alabama having the largest decrease in the southeast and third-largest in the nation regarding the use of the most highly-addictive prescription drugs.

In 2016 the Medical Association launched a new public awareness campaign called Smart & Safe, which is the only prescription drug awareness program in Alabama spearheaded by physicians. Smart & Safe promotes safe prescription use, storage and disposal of medication by providing helpful tips, news and educational opportunities online at

Last year, the American Medical Association also partnered with the Medical Association to create a new clinical tool in the fight against prescription drug abuse. The collaboration produced Reversing the Opioid Epidemic in Alabama: A Health Care Professional’s Toolbox to Reverse the Opioid Epidemic, a downloadable document housed on the Smart & Safe website, contains handy reminders about Alabama law pertaining to prescribing opioids, tips for disposal of medication, statistics and useful links.

“When we started the prescribing lectures, we encouraged physicians to prescribe dangerous combinations less. We discussed the impact of the combination of pain medications and nerve medications because adding together one and one does not equal two…one and one can equal three or four in the damage or the potential damage they do to the patients. We have presented this course to almost 5000 prescribers now, and we’ve had an impact there,” Dr. Harrison said.

This year marks the ninth year of the Association’s Prescribing courses. By the end of the year, the Association will have completed 31 courses, and until 2013 Alabama was one of the only states offering an opioid prescribing education course when the FDA developed the blueprint for Risk Evaluation and Mitigation Strategies for producers of controlled substances.

“We have to as a medical profession realize what we were taught 18-20 years ago, that we were not adequately treating pain and to increase the dosage of the pain medicine until there is a side effect, is no longer adequate. When you wake up in the morning and the first thing you think about should not be to reach for your pain tablet before you have your breakfast because you have to get going. I often wonder just what’s causing your pain first thing in the morning?” Dr. Harrison questioned. “You have to question your patients and be honest with them: Is that your pain talking, or is that your opioid rebound pain? When you and your patients start to look at that from a different point of view, then you can work together to decrease the amount of opioids used. Life is not pain-free, and opioids are not a cure for pain. It’s like licking the red off your candy. You’re making it so that the pain medicine doesn’t work for you as well as it used to. The more you take now, the less it’s going to work for you in the future. We’re part of the problem. And, if we’re part of the problem, we should be part of the solution.”

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Just a Guy with a Ladder with Lee Irvin, M.D.

Just a Guy with a Ladder with Lee Irvin, M.D.

MOBILE – You probably don’t know Lee Irvin, M.D., of Mobile, and he’s fine with that. He’s the kind of gentleman you’d love to hang out with and have a drink or dinner with…swap stories with. But it’s easy to see that his medical mission over the last couple of years wears heavy on his heart.

Dr. Irvin is a pain physician. Yes, a pain physician. He said he has no problem with introducing himself that way, even though there is a bit of a stigma associated with the treatment of pain, especially in Mobile following the arrest and conviction in February 2017 of Mobile physicians Xiulu Ruan and John Patrick Couch. Couch and Ruan were convicted in federal court for operating their clinics as pill mills, raking in millions of dollars by overprescribing potent, and deadly, narcotic pain medications to patients.

“It was like driving down the road, seeing a house on fire, and you’re the guy with a ladder,” Dr. Irvin said. “I was the guy with the ladder. Of course, I was going to help those patients.”

Dr. Irvin was the first physician in Mobile to treat patients with pain pumps more than 30 years ago, so he was the first physician to step up and render aid to the patients Couch and Ruan left behind who were on pain pumps. Dr. Irvin said he had about 35 of his own patients on pain pumps at that time, but there was an influx of nearly 350 pain pump patients from the now-closed practice in need of immediate care, some exhibiting signs of withdrawal by the time he intervened.

“Unfortunately, there were another reported 7,000 to 8,000 medication-managed patients from that practice that needed assistance,” Dr. Irvin said. “There was no way I could take on all of them, but in that year and a half, I took on another several hundred more. We were on a clock. It took almost a year to get those patients weaned off that medication. So, when you ask whether I had to do this, yeah…I did.”

One huge problem Dr. Irvin noted was the lack of resources for patients who have addiction issues, resources on the local and state levels that have left patients in need of specialized care falling through the proverbial cracks.

“We are in dire need of addiction specialists, social workers, mental health professionals – resources these patients need to get better. How can there be this tremendous need, yet we still do not have these resources to help our patients?” Dr. Irvin questioned.

Dr. Irvin continues to work closely with investigators with the Alabama Board of Medical Examiners to ensure the safety and health of the patients. As he puts it, “Doctors are supposed to help,” but he said he feels the reputation of most pain physicians has been tarnished by those who have put money above the welfare of their patients.

“When someone asks me now what my specialty is, I have no trouble saying I’m in pain management. I started in anesthesiology, but for the last 10 years or so, pain physicians have had such a bad reputation because of those bad physicians mistreating this profession and endangering the lives of their patients. We don’t want to write a bunch of narcotics to cover up an underlying disease. I have an old-fashioned idea that as a physician you should sit down with your patient and talk, get a complete history…and listen. It’s amazing how much information you can get from your patients if you just listen. I haven’t done anything amazing. I just listen and take care of my patients,” Dr. Irvin explained.

It may be an old-fashioned idea, according to Dr. Irvin, but his decision to make pain management his life’s work is actually deeply rooted in the illness of a family friend.

“I had a personal reason for specializing in pain,” Dr. Irvin said. “There was a fellow I grew up next door to who was like my second father. He was my hunting and fishing buddy. There were some kids out shooting while he was quail hunting, and he caught a .22 round in the hip. His doctors kept telling him it would do more harm than good to take that round out, but it was really a red herring. There was something else going on causing his pain.”

It was about 18 months later when Dr. Irvin’s old friend was told he had prostate cancer with mets. His pain wasn’t being managed very well, and one of the last times he visited with him, he had been warned that he might not recognize him…but he did.

“I wasn’t expecting that. He was in a lot of pain, sitting on a sack of medicine, and basically not knowing where he was, but he still recognized me. I couldn’t help but think there has got to be a better way. That was my moment. That was my reason for choosing pain medicine,” Dr. Irvin said.

Posted in: Physicians Giving Back

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