To my fellow CSA Physician Community,
I am overdosed on reading about overdoses. It seems just everywhere we turn —from national coverage on 60 minutes week after week, to the Wall Street Journal this week, to Sanjay Gupta’s “Town Hall” on CNN last week, we cannot escape the opioid epidemic. The problem was underscored in the Centers for Disease Control (CDC)“Morbidity and Mortality Weekly Report,” two weeks ago where our very own Bay Area counties were featured due to an outbreak of counterfeit Norco poisonings. The California Department of Public Health, local media, law enforcement agencies, and the Drug Enforcement Administration (DEA) are all implementing various response programs and investigations.
At least nine people in the Bay Area are believed to have overdosed on counterfeit pills that contained fentanyl. Four cases were in Contra Costa County, with the others in San Francisco, Alameda, and Santa Clara counties. In Sacramento, there have been 52 opioid overdoses since March, with 12 of those cases resulting in deaths. Lab analysis of the counterfeit pills found fentanyl, acetaminophen, promethazine and trace amounts of cocaine. Promethazine has not been reported in counterfeit pills before, according to Kathy Vo, MD, a UCSF emergency medicine expert, who authored the CDC report on the outbreak. It is unknown how the combination of fentanyl and promethazine together will impact patients. According to Dr. Vo, “We don’t know if it makes it more dangerous. And that’s really our main point. These pills can contain anything.” Because of the public health risk, county officials are sending out alerts to health care providers and schools.
Rather than try to surmise the causes and effects of this opioid epidemic, I’m writing this blog for an official Call to Action from our CSA physician members—yes that means YOU! Enough is enough in our communities. CSA physicians are situated in a leadership position to engage our patients and public on pain and opioid issues. We are all empowered to lead this. Grand Rounds in your community hospitals, city council meetings, op-ed pieces in your local newspaper, practice websites updates—all in an effort to let the public know the CSA community is aware of the issue, and is committed to providing safe pain care and opioid alternatives. Carefully balanced treatment plans for patients, along with critically important patient education about proper use of opioids when they are needed, is our specialty. We have an important role in educating the public while they are poised to listen.
There is widespread national attention right now on the opioid epidemic. This means we must seize this opportunity to talk about how to avoid opioids in pain treatment where possible, and how to properly prescribe and manage opioids for the subset of patients who will benefit from them. This education may help to reduce reliance on opioids, as well as reduce the incidences of addiction.
I challenge all of us as physician anesthesiologists to read, comment, educate, and LEAD – patients and the public WANT to hear you, and policymakers are trying to figure out what response is appropriate. Great education starts with talking to a patient one-on-one. Imagine if you could take your conversation with a patient—all the questions, all the time, all the care and compassion you put into it, and “scale” it to help tens of thousands of other people. That’s exactly what a great leader does. And CSA is here to help you execute on the ground with your outreach, media, and other opportunities that arise.
Together let’s work hard to educate and clarify misinformation about opioid use and abuse. Let’s educate our peers in the physician community about alternatives to opioids, but avoid putting a stigma on the medication for the patients who need it. And let’s make sure to educate our patients about the importance of adhering to the prescription directions, and how to properly dispose of unused medications.
Through this type of multi-faceted education we can tackle both the cause and the symptoms of opioid abuse.
Shalini Shah, MD is chair of the Pain Task Force for the California Society of Anesthesiologists and Assistant Clinical Professor and Director, Pediatric Pain Services at the Department of Anesthesiology & Perioperative Care at the University of California, Irvine.
Links to recent news coverage:
Overdose deaths linked to pills containing fentanyl
Senate takes action on opioid epidemic
Sacramento fentanyl overdoses show opiate addiction’s toll knows no boundaries
Another fentanyl-linked death, two more overdoses reported in Sacramento region