1

Pain and Opioids

BRET HAAKE MD, MBA

2/22/19

Handi Medical Supply

Annual Education and Equipment Conference

2

What Are Opioids

• Derived from opium poppy or chemically work the same:– Heroin– Fentanyl– Codeine – Vicodin/hydrocodone– Percocet/oxycodone– Dilaudid/hydromorphone– Methadone– Ultram/tramadol– Morphine

What do they do

• Block pain

• Mimic naturally occurring compounds (endorphins and enkephalins)

• Decrease both physical and psychic pain

• Disconnects a person from things that are disturbing

3

Appropriate Use of Opiates?

• End of life

• Significant tissue injury 

• Major surgeries

• “Handful of very painful conditions”

• Opioid addiction

Prescription Opioid Epidemic

15 million people on prescription opiates

7,500,000 recreational users

600,000 ER visits per year

150,000 admitted to hospitals

20,000 death each year

4

Opioid Addiction and the First Dose

5

Aggressive Marketing

6

Additional Facts

• 80% of all heroin users were introduced to opiates through prescription medications

• People who use prescription opioids are 40x more likely to use heroin

• Risk of opioid habituation after opioid use:Risk of  Being on Opiates One Year Later

Single prescription 7.5%

Second prescription 15%

“30 days of opiate medications” 30%

CDC:  MMWR Weekly / March 17, 2017 / 66(10);265–269

What happens with opioids after surgery?

• 83% reported taking half or less

• Leftover opioids were stored in an unlocked location in 77% of patients

PLoS One. 2016 Jan 29;11(1):e0147972. doi: 10.1371/journal.pone.0147972. 

7

How to Treat Pain Differently: “7 Years of Neck Pain”

8

What makes pain better

ExerciseReassurance & Education

Minimizing medications

Medication Efficacy in Dental Pain

JADA 149(4) n http://jada.ada.org n April 2018

Medication efficacy in dental pain

9

MRI Changes Without Pain

10

What are we doing?

• Specialized pain clinics

• Standards of care

• Increasing availability of addiction treatments

• Pain treatment with minimal opioids

• Collaborating statewide and nationally 

11

30% reduction in opioids prescribed

 ‐

 200,000

 400,000

 600,000

 800,000

 1,000,000

 1,200,000

 1,400,000

 1,600,000

Jan‐16 Apr‐16 Jul‐16 Oct‐16 Jan‐17 Apr‐17 Jul‐17 Oct‐17 Jan‐18

890K pills

1.2M pills -30%in two years

-3.4MDecrease in annual opioid pills prescribed

12

Fewer dental patients receiving opioids

Limits after root canals, wisdom teeth removal and other dental work

Still effectively managing pain

-91,500decrease in opioid pills in one year

Fewer low back pain patients receiving opioids

2,300fewer patients 

received opioids for acute low back pain in first six weeks

51%fewer patients 

received opioids after being diagnosed with chronic back pain

13

Reducing opioids through our health plan

Program to prevent multiple prescriptions

Review high‐prescribing clinicians

Limits on morphine equivalent dose of 90 mg per day

-2.5Mdecrease in opioid pills in one year

QUESTIONS?