Are doctors changing their prescribing habits?

BY Michael Hill, Correspondent |

Medical professionals from New York and New Jersey were taking notes at a “Do No Harm” symposium and staring at the staggering statistics for overdose deaths in just the first half of 2016 compared to all of 2015.

“Overdose deaths were up 41 percent over 2015, heroin at 43 percent, oxycodone at 46 percent and fentanyl, not including those analogs, was up 120 percent,” said Dr. Sindy Paul, medical education director of the New Jersey Board of Medical Examiners.

The Partnership for a Drug-Free New Jersey, Atlantic Health System, Prevention Links and the DEA say these medical professionals are the first line of defense against addiction. If they prescribe alternative treatments for pain and no or fewer pills, then patients can avoid getting hooked and ultimately turn to the streets for something cheap and dangerous. Doctors say overdosing on heroin or fentanyl can stop the brain’s breathing reflex. The DEA says the dark web has become a gold mine for suppliers.

“You can buy 100 milligrams of carfentanil right? That’s really an elephant tranquilizer. It’s used for large game, no one in the medical community outside of vets would use something like that and here’s their caveat: For experienced fentanyl users only. And look at the price, $250. You know how far 100 milligrams of fentanyl would go out in the street? So, this is what we’re seeing and how easy it is for folks. And, that’s why this is a game changer,” said Christopher Jakim, the assistant special agent in charge of the New Jersey Office of the Drug Enforcement Agency.

How did the opioid epidemic come to grip town after town?

“We made pain a fifth vital sign in health care. Controlling pain is important, but we may have overemphasized it and made prescribers a little more lax in prescribing pain medications including our narcotics,” said Pete Bolo, chairman of the psychiatry department at Overlook Medical Center.

The Partnership for a Drug-Free New Jersey began holding these events in 2013, and since then, says it’s seen a big change in medical professional prescribing protocol.

“Over 90 percent of the participants whether that would be a doctor, a dentist or nurse practitioner indicates that they are going to change their prescribing habits because of what they learned at these types of events. So, I think that the information that’s inseminated is really having a significant impact,” said Angelo Valente, the executive director of the organization.

The partnership was among the groups encouraging and applauding New Jersey adopting limits on initial prescriptions and having doctors discuss the dangers of opioids with patients.

“Working here at a hospital, day in and day out, treating patients there are far fewer patients coming in with, in my opinion, formerly excessive amount of narcotics that they have been prescribed in the past,” said Bolo.

Those are signs of progress, but some doctors wonder if the overdose-reversing naloxone is leading to more users experimenting with drugs.

“And they’ll sit around knowing that someone will rescue them for that. So, I mean do you see that as adding to the problem as well?” asked Dr. Robert Gasalberti of Northwell.

“Is that happening widespread? I doubt it. But, we can’t dismiss the lives that Narcan has saved,” Jakim responded.

Information sharing and education — the partnership says those are the key elements of its Do No Harm events and ending the epidemic.