Pilot project helps primary care doctors stop prescription drug abuse before it starts

When an overworked, time-strapped primary care doctor has a patient with chronic pain, the simplest, quickest response is to write a prescription for an opioid painkiller.

But although opioids work for short-term pain management, there’s limited evidence that they’re effective over an extended period of time. Meanwhile, long-term painkiller patients face the risk of dependence, addiction, accidental overdose and premature death.

In Maine, a pilot program has been launched with the goal of educating caregivers about how they can better help patients manage chronic pain. Over a year’s time, the Maine Chronic Pain Collaborative will identify the best ways to help people with chronic pain and then craft guidelines for treatment. By giving caregivers new tools to both aid people in chronic pain and to address a major threat to our public health, this initiative could improve the lives of tens of thousands of Mainers.

An estimated 100 million Americans suffer from chronic pain, including about a third of primary care patients. And opioid painkillers have become the first line of treatment for chronic pain.

Unfortunately, the widespread prescribing of opioids has resulted in the widespread abuse of the drugs, including pills that have been diverted from legitimate use. In Maine, the number of people seeking treatment for opiate abuse more than doubled between 2004 and 2013. And nationwide, the number of deaths from prescription opioid overdose has exploded: by more than 400 percent among women, and by 265 percent among men.

Given these dire statistics, the establishment of the Maine Chronic Pain Collaborative offers a reason for hope. It also provides physicians a much-needed source of support as they try to move in a different direction.

Doctors often have close ties with primary care patients, and they don’t want to put those relationships at risk by proposing a different approach, said Dr. Noah Nesin, of Penobscot Community Health Center, one of three groups that’s working with eight Maine practices on the pilot project.

Participants in the Maine Chronic Pain Collaborative will talk to each other and national pain experts about options to painkillers, such as antidepressants, anticonvulsants, chiropractic, massage, weight loss and physical therapy. They’ll discuss how to talk to patients in a way that’s firm and informed yet compassionate and nonjudgmental. And they’ll work on how to intervene gently but effectively when they see a colleague misprescribing painkilllers.

Primary care doctors are fighting two epidemics: chronic pain and painkiller abuse. If the Maine Chronic Pain Collaborative can better arm Maine caregivers for these battles, it will be a success.