UK Trauma Doc: 60%-70% of drug abuse starts with legal prescription, new protocol meant to help
University of Kentucky Trauma Surgeon and Chief Medical Officer Dr. Phillip Chang recalls a patient several years ago who was involved in a bad car wreck. The patient had valid reasons for severe pain, but the pain, Dr. Chang said, lasted too long. "And we started getting suspicious because he needed to be off pain medicine by now," he said. After investigating, Dr. Chang found out his patient had developed a drug addiction. "He had accumulated multiple prescriptions, close to 1,000 pills when we added them all up in a four to six week time frame."
Stories like that prompted the trauma team to rethink how they prescribe narcotic drugs for patients. "What we're doing, we may not be doing the best for our patients," Dr. Chang explained.
Those thoughts started new protocol for UK Hospital patients dealing with acute pain that should go away, like from surgery or trauma. The traditional way was to prescribe narcotics first, then add non-narcotics like Tylenol and muscle relaxers on top of the narcotics. So when the patient was weaned off the drugs, the narcotics were the last to go. Dr. Chang continued, "What happens is, you start with one drug, add a second, third, fourth, fifth, and then when you wean, you take the sixth, fifth, fourth and then you are left with the basic. If you start with narcotics, that the last one you get rid of. If you start with Tylenol, that the last you get rid of."
So now, they are starting with the non-narcotics, and working up from there if a patient needs more relief.
"What we're introducing to physicians is, lets not think of narcotics as a mainstay, lets think of everything else as the mainstay. That's not to say no narcotics, it is effective for the right patients."
Dr. Chang said 60% to 70% of those that become addicted get hooked from legal doctor prescriptions. "What I'm saying is we ought to pressure ourselves. I think this is a good first step. Our group, we look at ourselves in the mirror and think, OK, we are probably prescribing too much."