♪ Yá’át’ééh and welcome to Four
Directions of Wellness. I’m Roberta Diswood.
(Introducing clans) The National Center for Health
Statistics estimates more than
130 people in the US die everyday from
opioid related drug overdoses. The Center for Disease
Control has identified that American
Indians Alaska Natives had the
second highest rate of death from opioid overdose
in 2016. And in 2017 Health and
Human Services declared the opioid crisis
a public health emergency. The Shiprock service unit
in 2016 organized a chronic pain
management committee
to address the opioid crisis. Since then prescription
pain medication such as opioids has been
reduced by 50 percent. With us today to discuss the
committee’s efforts and
changes in chronic pain management is
the committee chairperson,
Dr. Thomas Quattlebaum. Dr. Quattlebaum, thank you
for being here today. Can you tell us a little bit
more about yourself? Sure thanks for having me. My name is Thomas Quattlebaum. My clans are Vietnamese on my
mom’s side and Bilagáana on my
dad’s side. I’m a family medicine
physician here, and I am the chairperson
of the chronic pain
management committee. Well again thank you for
being here. So why was the chronic pain
management committee formed? So there were a lot of reasons. Part of it is a response
to the opioid crisis as you
mentioned. And part of it was a need on our part to better
manage chronic pain in a more
systematic and holistic way. So one is we wanted to reduce
the opioid prescribing to improve the safety and
health of the patients here. And then also provide resources
for the providers here to
better manage chronic pain through both education as well
as direct kind of case based recommendations as well. And so who is on this
committee? So it’s a multidisciplinary
committee. We have practitioners from
all different fields. So you have medical providers
from family medicine, internal
medicine, mental health and psychiatry. We also have pharmacists, physical therapy,
representatives from the
substance abuse program as well as nursing and case
management that all participate in the committee. Okay, and so, what is the
purpose of this committee? So the purpose is several fold
like I said. So one I think the primary
purpose is to improve the way that we manage
chronic pain as a whole at the
service units and provide the resources to
providers as well as patients on how best to manage
chronic pain, because we know it’s changing. And then second is to make
sure that we’re following the
safe way of prescribing opioids and keeping our patients safe
from harm as well, so we don’t want to worsen the
overdose and opioid addiction
problem that’s present
in the country. So how is Shiprock Service Unit changing the way that it treats
chronic pain? So several different ways. so we know now that medicines
are probably not the best way to treat chronic
pain, and it takes a variety of
different treatment approaches. So we’re focusing on
incorporating all those
approaches into the care of each particular
patient. So it’s going to depend of
course on what the condition is, how we treat it. But so medications are of
course one part of it, but we want to focus more on
using other types of medicines
besides opioids to treat pain. And so we’ve expanded our
formulary so that there are different
options available now
whereas before they were a little bit
too costly. But now our committee has
helped to get those available
for patients. And then we’re incorporating
more physical therapy
modalities, working with mental health to
try and get some of our
higher-risk patients in sooner, and collaborating more directly
to try and meet the patient
where they are. So if they’re coming in for a
primary care visit, then we can try and have the
psychiatrist come over to meet
them at the same time instead of having them
schedule separate appointments. We also have new modalities that
are introduced here like something called osteopathic
manipulation therapy which is a treatment done
specifically by a type of doctor
called an osteopathic doctor. So we have that available
for patients. And soon we hope to have
acupuncture available hopefully starting beginning
of 2019. And then we’re also partnering
with traditional healers, both at Four Corners, and we
just have one that started here
at Shiprock recently. So all of those ways I think
are important to combine and to try and treat the
patient as a whole. So you mentioned earlier when
we were talking about like
treatments and stuff and alternative treatments, you mentioned physical therapy
modalities and also
osteopathic treatments. What are those?
Could you explain a little more? Sure yeah, those are good
questions. So different modalities that
physical therapy can offer
include: one is just education. So there’s research that shows
when patients are educated
about the way pain is processed in the body and how chronic
pain works, that they can kind of empower
themselves to take control of
their pain, and then have better management
of their pain. So that’s one thing
is just education. And we have several physical
therapists trained in and what
we call therapeutic
neuroscience education. so basically education about
the way pain is processed
in the body. And then of course they do
standard types of physical
therapy. Things involving core
strengthening, kind of addressing any
imbalances in the way people
walk or carry their body. And they’re also doing some
types of more like manual or
direct therapies with placing their hands
on the patients. And sometimes even what we call
trigger point injections or dry
needling, which involves putting a needle
into areas where the patient is
experiencing pain. And then yes the osteopathic
manipulation therapy, which that is a type of
manual therapy. So basically the doctor will
put their hands on the patient and adjust or manipulate
certain areas to either improve the way –
improve the posture of the
patient or improve the balance of the
patient’s muscles. And so there’s various
different types of specific
techniques. But that’s kind of the basics
of it. The doctor will be putting
their hands on you to adjust
things. It’s a kind of a simple way
of describing it.
Okay All right. Well, thank you. The National Survey on
Drug Use and Health reported 2.1 million people
have an opioid use disorder, and HHS declared the opioid
crisis a public health
emergency. So if you could help me.
First, what are opioids? Also a good question. So opioids are a type of
strong pain medicine that basically block pain
in the body. So if someone takes an opioid, they will reduce the sensation
of pain in their body. It doesn’t make the cause
of the pain go away, but it will make us not feel
the pain necessarily. They are a controlled
substance, and some common
ones include things like morphine, hydrocodone,
oxycodone and codeine
for prescription drugs. And then there’s also illegal
drugs like heroin that is also considered
an opioid. And so how do people
become addicted to these? Various ways. So one of the
more common ways actually is from getting a prescription
from their doctor for an injury
or you know something that’s
causing pain. And then a certain percentage
of those people might get
addicted to it based on that, because
when people take opioids, they tend to cause what we call
a euphoric effect or a feeling of getting high. So it feels good, and then some
people want to keep getting
that feeling. The vast majority of patients
I think do not get addicted. But there are some who do
from that way. And then other people kind
of cross over from different
substances and either take pills that were
prescribed to their friends or relatives, which you know
we’re not supposed to do. And then that can kind of get
them into the pathway of
experiencing those drugs. And so when we talked earlier,
you know, people are dying from
opioid-related overdoses at an
alarming rate, and what is our service unit
doing to combat this? So yes we are definitely
concerned about that. So we’re doing a lot of
different things. First off, is the kind of the
primary preventive which is reducing the amount of
opioid prescribing in the
first place. So trying to really identify
when are opioids really needed, and then only prescribing them
in those certain cases. And then trying to limit the
amount that goes out, too. So we know we have more
information now that we probably don’t need to
be prescribing as much opioids
as once even for like after surgery or
an injury or something like
that. Most patients don’t need them
for longer than three days. And by a week, really most
patient’s don’t need them
at all. So that’s number one –
prescribing less. The second way is to increase
the access to a medication
called naloxone. So that’s a reversal agent
for opioids. So if someone accidentally
takes too much opioid that will cause them to, what we
call, have an overdose which can lead to not breathing
and death is the worst case. So naloxone, if given soon
after an overdose, can prevent that and bring the
patient back basically. So it’s a life-saving medicine, and anyone can be trained
to use it. It’s very simple to use.
And so the pharmacy is dispensing it
to our patients, and also emergency personnel
like EMS out in the community
have access to it as well. One more thing that we’re
working on is using suboxone which is a medicine used to
manage opioid addiction and
it’s safe and it doesn’t cause overdose
like traditional opioids do. You talked about naloxone. Are there anything that can go
wrong with it or anything about
using it? That’s a good question. So no not really. Even if a patient is overdosed
from some other reason, or I mean unconscious from
some reason like alcohol or
another drug, giving naloxone won’t be
harmful to them regardless. And if there was opioids, then
it should help them to wake up. Well, that’s really good to know
though, that especially about
something like that. And you know we talked about
healthcare. Opioids serve a
valuable purpose. When do we need it? Yes, I think it’s important to
remember that opioids are not
evil necessarily or overall a bad thing. There are some important uses. So one thing would be for
patients who have cancer
type of pain. That’s, you know, won’t go away. We know for that reason it’s
essentially very effective and can help improve quality
of life for patients. And then the other reason
would be for like an acute
severe injury or after surgery. And like I said before, even
then it should be for a short
duration. And then even in some of those
cases, they’ve done some studie, where in the ER, they compare
opioids to medicines like
ibuprofen or Tylenol. And it actually seems like,
for a broken arm for instance, and it actually seems like both
do about the same job as
each other. So they have equivalent pain
control. So it’s just learning to figure
out when exactly it’s needed
and not. Right. Right.
Okay. Well to finish this show, I’d
like to focus on the patient. When a patient has been on
opioids for a long time and they may have developed
an addiction, how do we change they’re
medication and treat that
addiction? Yeah, it’s a great question. So I think that,
well first of all, I think that most patients who
are on opioids long-term
are probably not addicted. They have developed some
dependence on the medicine
just from being on it
for so long. And in their body, it’s kind
of use to it, and it’s hard for them to
not be on it. Which is a little bit
different than addiction where they kind of crave
the medicine and are going to other lengths
to take it if they don’t
have it. So to treat the addiction if
it’s identified, I think it’s
important to have open conversation with patients
about it and express concerns. The same thing for
community members. If you are worried about a
family member or someone you
know being addicted, I think talking to them about
it, encouraging them to talk to
their doctors about it,
is important. But we have lots of different
ways to treat it. One of the emerging ways
is to use a medicine called
suboxone, which helps to block some
of those cravings and also prevent the risk
of overdose in patients. So a lot of times when
patients get on this medicine, they feel like they can go
back to having a normal life instead of constantly feeling
the need to get opioid
pain medicine. And then kind of along with
that is involving mental health
and other substance abuse
counselors in having the patient talk
about their issues is also
really important. So when patients have been
taking this, how do they usually feel when
they stop taking their
pain meds? That’s a very good question. So I would say from my own
personal experience and from
other’s stories, the vast majority of patients
either feel better
after stopping or notice no difference. So most patients feel
perfectly fine. There can be what’s called a
withdrawal period after
abruptly stopping, but we try to work with
patients to minimize that and kind of go down slowly
on their medications. And then some patients even
told me afterwards they didn’t even know why they
were taking the medicines
in the first place and feel a lot better – feel
like they’re kind of out
of a fog – don’t have to deal with some
of the side effects that
opioids cause like constipation, drowsiness,
just feeling tired all the time. So yeah, I’d say most patients
feel either better or the same. Well, I want to thank you
for being here today. Okay, thank you for having me. This has been Four Directions
of Wellness. Hágoónee’. ♪