Pain Management, Meet Public Health

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Sarah FudinSarah Fudin is the community manager for the George Washington University’s innovative online Masters in Public Health program. Sarah enjoys working with public health graduate programs as a way to positively effect change and become a life long learner. Follow her on twitter at @sarahfudin and @GWonlineMPH.

Public Health has a deep connection with pain management that is sometimes forgotten or unrealized. It is important that we draw the association between public health advocates and pharmacists, health practitioners (MD’s, NP’s, PA’s, dentists, podiatrists), nurses, and others for people dealing with the challenges of acute and chronic pain. If public health advocates and pain management specialists join together, there will be a more integrative approach to confronting the challenges that patients face.

Over the past few months there has been a lot of attention around certain pain management activities resulting in media frenzy. It seems like now is the perfect time to alert the public of these issues, if they aren’t already in the know, to help create policy and knowledge around pain management.

If you’ve missed the news, here’s what’s going on:

Mayor Bloomberg’s New Task Force

In response to the increasing abuse of prescription painkillers, Mayer Bloomberg created the multi-agency Task Force on Prescription Painkiller Abuse. The task force is co-chaired by Linda Gibbs, Deputy Mayor for Health and Human Services and John Feinblatt, Chief Policy Advisor, and was created to develop and apply integrated strategies to respond to the increase of opioid painkiller abuse and distribution in New York City. The abuse of opioids has become a public health threat with a massive increase in abuse over the last decade.

The problem herein lies with the patients that are actually prescribed these opioids and need them to manage in their every day lives. Medical doctors and pharmacists have been portrayed in a negative light and have come to fear prescribing and dispensing opioid painkillers for patients that truly need them.  As public health advocates, we must understand both the people in need of these painkillers and the people abusing them to find the best way to monitor and mitigate this problem while still providing essential care to legitimate pain patients.

Check out this campaign launched by the NYC Health Department to shed light on this issue to the general public:

Meningitis Outbreak Investigation

In response to a multi-state fungal meningitis outbreak by New England Compounding Center (NECC) patients, the Center for Disease Control and Prevention (CDC), state and local health departments and the Food and Drug Administration (FDA) have teamed up to investigate. The CDC has received reports of spinal epidural abscess and arachnoiditis among a number of patients who were receiving treatment for fungal meningitis.

In response to this outbreak, the NECC voluntarily recalled all of the products from their Framingham, Massachusetts facility as did other facilities as more contamination was identified. The teamwork of public health officials to continue to announce updates as well as the medical worker’s vigilant efforts to remove contaminates and continual research is commendable. There is much work to be done to figure out the reason for this outbreak and how we will prevent future outbreaks. Government officials have been working diligently with ASHP and other national pharmacist groups to establish workable polies moving forward.

For more updates, follow the CDC’s investigation.

Rescheduling of Hydrocodone in NYS from CIII to CII

What we’ve found is that the medications that work best for treating pain are also the ripest for abuse. Because of this, drug safety policy is skewed towards making these medications more difficult to acquire and stockpile.

A few weeks ago the FDA Drug Safety and Risk Management Advisory Panel voted in favor of rescheduling hydrocodone from CIII to CII. But just last year, the FDA decided not to reschedule hydrocodone after much pressure from certain advocacy groups and the DEA.  Those suffering from these decisions are patients in chronic pain that have little resources to make a public stand, and who are less likely able to make a trip to Washington to advocate for their position because of inability to travel and/or work regularly. As public health advocates, we must take their voices onto our shoulders and champion for their positions to be heard.  We must make sure patients who are in need of medication are able to receive it while at the same time monitor those who are abusing these medications.  This effort will take hard work from pharmacists and prescribers – patients must be monitored closely!

For more insight see Dr. Fudin’s article: Effect of Rescheduling Hydrocodone is Unknown.  Also see Hydrocodone: Potency, Popularity, Politics, & Practicality.

There are a ton of policy creators, advocacy groups, patients and healthcare providers working diligently to provide the public with the best medications, treatments and updates. It is important that we continue to work together to shed light on current issues and lobby for important causes.

11 thoughts on “Pain Management, Meet Public Health

  1. Sarah: great to hear from you. When I lived in NYC (until 2003) the environment had already become so difficult to navigate that even when my doctors would Rx pain meds I could barely find *pharmacies* that were willing to stock the meds. Eventually I had to travel to Connecticut every month to see a pain doc and to fill my Rxs, which was beyond both my functional capacity and my budget. It was one of the main reasons I had to move back here to the West Coast to live where family can help me–not something I ever wanted to do, and certainly not at age 37 with my “real life” back in the city. Just to contribute another personal story…also, Dr. Portenoy, whose clinic treated me for awhile, told me that he trained a new set of docs every year specializing in pain management, and every year at the end of training they ALL left New York State to practice because the environment there was so punitive for pain management practitioners. It’s a serious problem (as you know), and too sad in a state that is otherwise progressive and generally humane to its citizenry.

  2. Dear Dr. Jeff, and Wonderful Daughter………………..I’m a member of “COFWA”, I think you know us. Everyday, everyday, and now, every few minutes. We have someone in our group that finds’ it more difficult to get the medications they need. I want to cry, I truly want to cry. I’m a big old strapping X Soldier, and it makes’ me weep to see what prop is instigating, and the folks of COFWA, every single day are finding it harder and harder to get the meds they need JUST TO FUNCTION. I swear To God, I would do anything to help. It’s up to good people like Dr. Fudin, and people that post here to truly get out the word, and get the folks that really need these Opioids, and end this madness. When I see the initials, “PROP” these days, and like one of the folks said above, “Their DRACONIAN views.” People like Bloomberg of New York. (I won’t even call him mayor)…………The commercials on tv, are they really helping? I feel so sorry for the one’s that do overdose. The ones that are illegally getting the pill mills to write them constantly for a cheap high. Hell, I will leave it at that, I’m tired………doc Neeland,,,,,,,,not a doc, just was a medic in the service. All Medics were “Docs”.

  3. Congratulations SarahF! Public Health issues are rampant in the fields mentioned above and hopefully some people in the program will take a closer look at the adverse public health outcomes caused by the disease of chronic pain. Even in the recent “meningitis outbreak” the real public health issue is the far full extent of the disease, since the “meningitis” cases are not the major infection. Rather infections around the injection site continue to evolve. These infections, abscesses, osteomyelitis, discitis, facet arthritis, serious and life altering and life threatening. One of the ongoing public health issues will be the medical care in the future for people exposed. Will they be candidates for immunosuppressive treatments in future years if they survive the initial infection. This would include treatment of many arthtitic conditions, and those that generally are treated with steroids. Exposure to these treatments can predispose people to fungal infection and they can predispose them to reactivation of previously quiescent infections.

    It was also an epidemiolgist looking at the public health issue of falls among pain sufferers who published articles showing the close association of falls to chronic pain: Dr. Janet Leveille, in JAMA, Nov 2009 and in (I believe) Journal of American Geriatric Society.. Falls cause harm and injury but they are largely ignored among chronic pain victims.

    SarahF, I wholeheartedly agree with your father,that there is an immense role for the field of Public Health in the study and evolution of just and proper treatment of those who suffer the disease of chronic pain. Thank you for your work!

  4. The one issue that I see being ignored frequently is how inflated the opioid pain medicine overdose/death rate is. As well as implementing new safety measures, why can’t government agencies be more honest and accurate about the cause of death? It is completely unfair and unjust for lawmakers and organizations(like PROP and ARPO) to push for draconian controls on opioid pain medicines by using incredibly biased and extremely inflated data. The inflated data only increases the hysteria among the public and generates unjust fear of pain patients and opioid pain medicines.

    If the government is going to force patients to be honest about their medication use via programs like PDMP, then they must honest and held accountable too.

  5. Good post, Sarah… hope to see more from you. It’s always fun when public health is the “family business.” My own daughter is a licensed clinical massage therapist and student of many CAM therapies for pain. We have some very ‘interesting discussions’ about evidence-based pain medicine.

    1. Stew: You’ve been holding out on me! Your daughter is a “clinical massage therapist”? The way things have been going in the media, I think I can use her services! Thanks for your comments as always! Jeff

  6. It seems in the past 2 years this abuse of opioid medications has spiraled out of control, yet people continue to abuse these medications after all the bad press we hear. Thing is these people will never stop this abuse unless they make up their minds to stop. Just like a person that drinks alcohol that cant control their intake the same thing happens with people that abuse pain medications like Vicoden. The only thing these people can think of is how to get more of these pain pills their addicted to.

    Everyone wants to blame doctors, or they say the laws we have are not strict enough to blaming opioid medications for the addiction of a family member.
    Its time people assume responsibility for their own actions, no one can do it for them, either they make up their mind to get better or continue to spiral downward. Eventually opioid medications will win and take the life of a person that’s abusing and addicted to them, I’ve seen it happen to a very good friend.
    No matter how much I screamed at a friend of mine she continued to abuse opioid pain medications .I found I was not trying to reason with her I was trying to reason with her addiction and a addiction does not listen. I called 911 several times and tried to get her help but finally her addiction took her life.

    When a group of doctors named PROP sets out to correct the worlds wrongs when it comes to the abuse of opioids they most certainly will add to the problem.
    I hope and pray that when the FDA makes their final decision it’s the correct one. People that suffer from chronic pain deserve to have the pain treatment they need so badly and the people that abuse these life saving opioid medications need to get the help they need to stop this abuse. We cant let people that suffer from chronic pain continue to suffer because of those that abuse the very medications that give a chronic pain sufferer a life worth living.

    Thank you Sarah and Dr. Fudin for the continued hard work you all do for those suffering with chronic pain.

    Mark S. Barletta

    1. Mark – You seem to have a unique perspective given that you saw a friend suffer through opioid abuse — thanks for commenting and sharing your story!

  7. Nice work Sarah! Thank you for the post. And just as I was reading your first guest post, these came through as a view alert from NABP:

    California Bill Would Implement Stricter Requirements for Pharmacies Compounding Sterile Drugs

    Prescription Drug Misuse Contributes to Continued Increase in Overdose Death Rate

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