Professionals, students adapt to handle addiction
As drug addiction continually evolves, so too does the classes USD medical students take.
Associate Dean of Basic Biomedical Sciences Steve Waller has been teaching physician assistants and medical school students about substance abuse in a required pharmacology class since 1983, and said the issue has been evolving.
“It’s been interesting watching it evolve because early on it was really the illicit drug process that occurred. The heroine overdoses, the morphine abusers,” he said. “And what’s happened in the last decade is the shift to medications being taken from someone else that’s using the opiates for pain.”
He added that teaching methods have evolved as well.
“We’re much more aggressive in teaching it now, but that’s been a shift in medicine for some time,” he said.
Janet Lindemann, dean of medical education, worked as a family doctor for 30 years prior to coming to USD.
She said though addiction has always been a part of the conversation, the issue is now re-enforced multiple times throughout students’ time in medical school.
One major challenge doctors face today is deciding whether or not to prescribe patients highly addictive pain medications, Lindemann said. It’s natural to trust the patient, but now prescribers are looking for “conversational cues” indicative of abuse.
“It’s always been a part of the curriculum, but the challenges are becoming more and more important,” she said. “I think 10 years ago the topic was don’t be afraid to prescribe these medications. But now the appropriate prescribing and the addiction potential is rising as a more important topic.”
Tracking prescriptions
Davis Pharmacy owner Matt Lavin said he believes the flow of prescription drugs is being better-controlled than in previous generations.
“The tools available to providers, whether they be physicians, mid levels or pharmacies, are far more extensive than they’ve ever been,” he said.
Pharmacists at Davis check the state’s Prescription Drug Monitoring Program (PDMP), a database that tracks controlled substance prescriptions by patient, on a daily basis, Lavin said.
Though the database doesn’t include information from other states, Lavin said change is coming. He also said this will be especially important in “corner communities” like Vermillion, where an abuser can potentially fill prescriptions across multiple states in a matter of a few hours.
In addition to utilizing PDMP, Lavin said pharmacists and providers communicate on a regular basis to ensure patients are using their prescriptions appropriately.
“The providers who are prescribing and the pharmacies that are dispensing, I feel, are doing a much better job of educating patients,” he said. “None of either group want product out there that shouldn’t be out there or doesn’t need to be out there.”
Murphy Mack, a staff pharmacist at Sanford Vermillion, just graduated from SDSU last May and said he sees a “fair amount” of new doctors. He said though they’re often very prepared, it still takes experience to learn and recognize the behavioral patterns of addiction.
“I think they’re prepared as they can be,” Mack said.
Though he doesn’t use the PDMP as often as employees at a retail pharmacy, he does check the database for trauma patients, he said.
Controlled substances are heavily regulated in both retail and hospital pharmacy settings, Lavin and Mack said.
“We do so much more as providers and pharmacists with a controlled substance than anything else,” Lavin said. “It’s more time-consuming, there’s more record keeping, the laws are far more extensive involving them.”
Mack added that inventory records on those substances are very strictly kept.
“If there’s one tablet missing, we know about it,” he said.
‘A never ending battle’
Waller said though opiates are an important resource for the highest level of pain, often in terminally ill or cancer patients, doctors are encouraged to seek other pain management techniques with less abuse potential first.
“You don’t run to your pad and quickly order those drugs,” he said. “Those are significant medications. They carry with them a great deal of risk.”
Another shift in medicine is the increased emphasis on counseling, Waller said. Especially because people are often more likely to listen to their doctor than other treatment professionals.
“The counseling is there to re-enforce the process,” Waller said. “And it’s done in very subtle ways. Rarely will you go to a health provider now and not be asked, ‘Do you smoke?’ That subtle question really has evolved very rapidly over the last several years.”
Though Addiction Studies Department Chair Frank Zavadil doesn’t work directly with medical students, he said he has noticed the changes in the medical field in regards to addiction.
“I think that they’re more open to this education and information than they’ve ever been before and I think it’s just a result of being more open or sensitive to the people they’re working with,” he said.
The PDMP and other drug monitoring resources are “key” to at least decreasing abuse in patients that aren’t already addicted, Zavadil said.
“But you wonder, if you shut off one supply or route how people will find another. And that I don’t know,” he said. “(Addicts are) always one step ahead of you.”
Lavin said even with the increasing resources, drug-seekers will always find a way to get what they want.
One of his favorite quotes, known as Berge’s Law, states: “Addicts are smart, we are smart. They are desperate. We are not. Therefore: they are going to outsmart us every time.” He has the saying posted on the outside of his narcotics cabinet.
“It’s a never-ending battle,” he said.
