Public Health

America’s Opioid Epidemic: What Doctors Need to Know

Q&A with Dr. Surita Rao, UConn Health assistant professor of psychiatry

Q

Can you characterize the U.S. opioid epidemic?

Our country’s opioid epidemic has been going on for several years. The U.S. is the biggest global consumer of prescription opioids. In 1997, 76 million prescriptions were written, more than doubling by 2013 to 207 million. Americans consume nearly 100 percent of the world’s hydrocodone (Vicodin) and 81 percent of its oxycodone. The majority of those physically addicted or overdosing are getting opioid prescriptions from their doctors’ offices.


Q

What are the dangers of opioids?

These strong pain pills are very physically addictive and it’s often hard for patients to live without them, even after their pain subsides. The biggest dangers of opioids are overdose and death. After doctors stop prescribing them, some patients turn to the street to illegally get their pills, while some may even switch to heroin. When mixed with heroin, anxiety medications, or alcohol, opioids are even more likely to lead to overdose.


Q

What do the new Centers for Disease Control and Prevention guidelines call for?

In March the CDC called on primary care doctors to more carefully assess each individual patient’s risk of taking an opioid and to take extreme caution when prescribing it for longer than seven days for acute pain, unless for terminal cancer or palliative care. The lowest-effective dose of non-slow-release pain pills should always be used, and patient use needs to be continuously reevaluated. Guidelines stress the critical need for increased education and communication about opioid risks including constipation, drowsiness, stopping breathing, drug and alcohol interaction, addiction, overdose, and death.


Q

What should medical providers keep top-of-mind?

For patients, physicians should always consider first NSAIDS (such as acetaminophen and ibuprofen), routine exercise, physical therapy, hot and cold compresses, and possibly steroidal injections. If opioids are necessary, beware that long-term opioid use can lead to physical dependence and intense withdrawal. Patients should be slowly weaned off. Patients who have developed an addiction to opioids that goes beyond a physical dependence will need to undergo medical detox, or take agonist maintenance medication to curb their brain-receptor cravings. Psychotherapy specifically targeted for substance abuse disorders, including individual counseling and group therapy, is always needed for successful recovery from an addictive illness. Patients should be encouraged to proactively lower their daily pain risk factors, not abuse or share opioids, and seek medical attention if they start to experience withdrawal symptoms or addiction.

Summer Breaks Help Prevent Burnout, Especially Among Physicians

Young man jumps into a body of pristine water on a summer day


It’s summertime, and you need a break! The U.S. has a culture of working too hard, and physicians are some of the worst offenders. Don’t let Labor Day pass without spending at least one afternoon at the beach.

We can joke about it, but there’s rising concern about burnout and depression among physicians. One recent study of 7,000 residents found that 50 percent showed depressive symptoms and 8.1 percent reported suicidal thoughts over a 12-month period.

“Physicians are given enormous workloads, make near-impossible life-and-death decisions regularly, and are expected to be alert and ready to go constantly. It’s unsustainable,” says Dr. Adam Perrin, a professor of family medicine and director of student wellness at UConn Health. “To enjoy life, you need balance and a break.”

Working too much can lead to burnout, or at the very least, a lack of enthusiasm. And that can be bad news not only for doctors, but for patients.

Taking care of yourself is taking care of your patients, too — even when the worst happens.

Studies show that depression and burnout make doctors significantly less likely to read about the next day’s cases, and up to five times more likely to make errors when prescribing medication.

Many doctors work too much because they don’t want to ‘abandon’ their patients. But taking care of yourself is taking care of your patients, too – even when the worst happens. Telling a dying patient that you have a vacation coming up, you regret the timing, and you wanted to tell them how much you care before you leave is very respectful, and patients are usually understanding,
Perrin says.

And while vacations are essential, your recovery and rest shouldn’t center on them. Rest and self-reflection should be a regular pursuit. For example, Perrin sings in a community choir.

“I’ve made many friends, we sing gorgeous music, and it fills the soul,” Perrin says. However you choose to take a break this summer, we hope it does the same for you.

When Getting Your Flu Shot, Timing is Everything

Elderly patient being tended to by a nurse


Pharmacies advertising flu vaccinations in August and September are doing their elderly clients a disservice, say UConn Center on Aging researchers. The immunity they gain from vaccine in late summer may wane by the time flu season hits hard in late winter.

As summer temperatures peaked this August, pharmacies were already advertising the influenza vaccine. But if you thought that was too early to be getting a flu shot — you were right.

If you’re interested in volunteering for the study, contact Lisa Kenyon at the UConn Center on Aging at 860.679.3956.

“When adults get the vaccine in September, the peak effect wears off by late December. But flu season peaks in January and February,” warns Laura Haynes, an immunologist and gerontologist at UConn Health.

October or November is a much better time to get the vaccine. That way, you’re still protected when virus season is at its worst.

This is especially important for the elderly, who are at particular risk from flu. People over 65 are much more likely than younger adults to have serious complications or even die from a bout with the virus.

One way to better stimulate the immune response is to administer a high-dose vaccine, which contains four times as much flu antigen as the regular version. But the high-dose vaccine has stronger side effects, is more expensive, and may not be best for everyone.

Haynes and her colleagues at UConn Health, funded by a Program Project Grant from the National Institute on Aging, will run two studies this autumn to better understand older people’s responses to the regular flu vaccine and the high-dose version. The studies will look at how the immune system reacts to the flu vaccine, as well as how to identify patients who would benefit from the high-dose version.