Rx Summit: Practices, not opioids, are the enemy

A health professional who has treated many veterans experiencing pain urged a National Rx Drug Abuse & Heroin Summit audience to avoid demonizing opioid medications as part of their response to the prescription drug crisis.

Speaking April 18 at a session on treating special populations, Anthony Dekker, DO, director of addiction medicine at the Northern Arizona Veterans Administration Healthcare System, echoed comments of some other presenters at the conference who warned against the pendulum swinging too far toward restricting access to opioids.

“The VA is now rewarding doctors who stop prescribing opioids—that is not an answer,” said Dekker.

He said only six of a group of 86 of his patients were found to have received opioids from outside the VA, and four of those cases were related to dental emergencies (in other words, not cases of doctor-shopping).

“Not everyone who uses them becomes addicted,” Dekker said. “It's not the dose. It's not even the medication. It's what happens to people when you give them those things.” It is improper prescriber and system practices, not the pills themselves, that should be under attack, he suggested.

Not for the faint of heart

Dekker said pain represents the number one reason veterans access the healthcare system. He added that a good number of veterans from recent conflicts are experiencing a triad of pain, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI).

This results in a patient population that is challenging to treat and that can be manipulative and otherwise difficult for the clinician. “If you need to be stroked in your business, you're in the wrong business,” he said to some laughter from the workshop audience.

He emphasized in regard to treatment that there is no exact science, saying for example that some patients do well on 2 mg of buprenorphine while others may struggle with 16 mg. He conveyed the importance of working with patients as individuals.

“I don't fire patients,” Dekker said. “It's safer for them to stay in treatment.”