The Register-Herald, Beckley, West Virginia

February 13, 2014

Beckley psychiatrist pens article on opiate drug abuse

By Wendy Holdren
Register-Herald Reporter

BECKLEY — The West Virginia Medical Journal recently published an article written by a Beckley psychiatrist who examines the challenges health care professionals face while working with prescription pill abusers.

The article, “Opiate Drug Abuse: Discovering Problematic Patients in the Office and What to Do About It,” written by Dr. M. Khalid Hasan, discusses risk factors for abuse, signs of addiction and recommendations for proper treatment.

According to the article, risk factors for opiate abuse include being younger than 45, having a history of substance abuse or having a psychological behavior associated with impulsivity, lack of religious affiliation, dysfunctional family background, immature personality characteristics, genetics, physical or emotional abuse as a child, high availability of drugs, relaxed laws and social norms, as well as having a low socioeconomic status.

Hasan also notes indicators that a patient is addicted, such as requesting early refills, multiple episodes of lost or stolen prescriptions, resisting to comply with toxicology testing, going to multiple physicians and multiple pharmacies for prescriptions and refusing other treatment options.

Hasan describes treatment as “biopsychosocial,” meaning it involves the patient, the patient’s family, pharmacies, police, physicians and education.

“Treatment requires establishing a therapeutic alliance with the patient and educating the patient and family about relapse and risk factors,” Hasan writes.

He encourages physicians to use education, pharmacotherapy, cognitive

behavioral therapy, motivational enhancement therapy, 12-step programs and other psychosocial programs, such as Narcotics Anonymous or Alcoholics Anonymous.

As for methadone treatment for opiate-addicts, which has been recommended as standard care for addiction by the National Institute of Health, Hasan said this form of treatment is viewed negatively by patients, physicians and society in general.

Methadone has been proven to decrease opiate abuse and crime through decreasing the craving for the drug, but Hasan said for-profit clinics are hesitant to eventually taper patients off the methadone treatment.

“Some pain experts feel that this medication is a lifelong treatment while others do not.”

Hasan said no studies have been conducted about how long the treatment should last.

“It is also estimated that 50 percent of the patients on methadone would like to get off the drug if they had the option.”

Hasan recommends avoiding cash systems, which can create “ a culture of greed” as many people perceive the for-profit clinics as generating income for “the underworld of drugs.”

He also recommends mandated counseling, detailed logs of medications used, drug treatment programs being accompanied by psychosocial behavioral management and pharmacy restrictions for patients.

Hasan said he believes pain clinics need to be highly regulated to help prevent over-prescribing.

“Only a trained pain physician with a fellowship in pain management should operate the clinic. Physicians should be present 100 percent of the time. Prescribing should not be delegated to a physician’s assistant or nurse practitioner. Ownership by non-physicians should be avoided.”

Pain clinics, Hasan said, are commonly viewed as “legalized drug pushers,” and periodic audits of these clinics need to be performed.

He also would like to see the Drug Enforcement Administration review Schedule II drugs more seriously, as well as consider decriminalizing marijuana.

“Overall, prescription drug abuse has reached epidemic proportions and has the potential to spiral out of control. The implementation of more stringent guidelines and broad reaching education programs are imperative to stop this trend. The numerous patients visiting physician offices and emergency rooms for chronic pain have made the health care providers de facto hostages, however, the eventual victims are the patients themselves who are not receiving the treatment they need and deserve.”

This article was published in the January/February 2014 edition of the West Virginia Medical Journal.

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