Epidemic Prompts 'Sea Change' on Opioids
By ANDREW KING
ThisWeek Community News
Dr. Bruce Vanderhoff, OhioHealth’s senior vice president and chief medical officer, remembers a time when opioids were thought to be a necessary evil.
When he was a younger doctor, Vanderhoff recalls the commonly accepted side effects of surgeries, including a variety of digestive issues. One culprit, he now knows, was the opioids prescribed for recovery.
“Most of us were trained to interpret much of the constipation after abdominal surgery as an inevitable result of the surgery invading the abdominal cavity,” he said. “What we’re discovering is that the opiate medicines we prescribed with the best of intentions were more the culprit than we imagined.”
That paradigm shift is a microcosm of the larger conversation happening within OhioHealth regarding the use of opiates.
It’s not realistic to end opioid use entirely, especially for patients with unbearable pain. But for Vanderhoff, one of OhioHealth’s most important projects is fine-tuning the use of those opioids and changing how healthcare providers think of the drugs.
“The advent of this opiate epidemic really prompted what I can only describe as a sea change in the practice of medicine,” he said. “For many, many years before we recognized this epidemic, pain had evolved to be viewed as a so-called ‘fifth vital sign.’ Physicians were expected and held accountable for working to eliminate patients’ pain and the goal was to be completely pain free. This was reflected in national quality surveys, national benchmarks and measures.
“Today, we realize that eliminating pain is not the appropriate goal, but rather helping our patients be comfortable and functional is the right goal. Because some degree of discomfort may actually be an important signal the body is giving about what is going on in the healing process.”
For Vanderhoff and OhioHealth, “that’s a very different goal,” and one that they’re trying to achieve through education, policy changes and having physicians more “heavily involved” in teaching their co-workers.
“We’ve had to ask, ‘How do we make this change? How do we make this paradigm shift in clinical practice?’” Vanderhoff said. “We realize it begins with education and awareness. It begins with working with patients and communities to make people more aware of the dangers of opiate medications and recognizes their real risks, setting goals that are more appropriate when it relates to pain management and care.”
Part of this new implementation is giving young doctors the right frame of mind for the start of their careers and advancing those who understand the importance of drug management.
Dr. Krisanna Deppen, who specializes in addiction medicine and family medicine at OhioHealth Family Medicine Grant, said the system is “training people to do better” than what came before.
She said OhioHealth has been holding surveys regarding the stigma of addiction and communities’ attitudes toward it. It’s holding monthly substanceabuse seminars and trying to spread the word about what addiction is and how it can be handled.
Perhaps more importantly, Deppen and other specialists now have a voice within OhioHealth and beyond.
She said addiction medicine only has been recognized by the American Board of Medical Specialties since 2016, which hasn’t given them long to catch up.
But now, OhioHealth has a special addiction medicine fellowship, which gives two young doctors an extra year of on-the-job training beginning this August.
“We’re grown up; we have a seat at the table,” Deppen said. “So we’re training doctors to do this work and to put it into the healthcare system so that it’s part of what we do.”
And for Vanderhoff, that training from younger generations is an important part of changing the culture.
He said he hopes, with the new knowledge and specialists available, that the “sea change” becomes widespread.
“Physicians and other care providers rely on their training; they rely on the education,” he said. “And it’s always based on the best observations available at the time. But the common use of opiates in the perioperative period, frankly, scientifically blinded us to their impact. Now, that impact is far better understood.”