Coastal Orthopedic pain management specialist plays roles as Mother Teresa and Sherlock Holmes when prescribing opioids

More than 20 years ago, Dr. Richard Bundschu, a pain management specialist for Coastal Orthopedics, sat in a packed conference room with hundreds of fellow doctors and listened to a lecture on the societal belief that doctors were not treating pain adequately.

It was the mid 90s, and at the time, it was widely considered that doctors needed to be more aggressive and aware of their patients’ pain and do whatever they could to help them get through the day. For a majority of patients that meant prescription narcotics, such as Percocet, Vicodin and OxyContin, a long-term painkiller introduced by Purdue Pharma in 1996 to treat moderate to severe pain.

Over the next decade, stories of addiction, drug abuse and dependency routinely made headlines as the U.S. began experiencing an epidemic of drug overdose related deaths. According to the Center for Disease Control and Prevention (CDC), since 2000, the rate of deaths from drug overdoses has increased 137 percent, including a 200 percent increase in the rate of overdose deaths involving opioids.

Opioids are a group of drugs that include heroin, fentanyl and prescription painkillers, such as oxycodone, hydrocodone, codeine and morphine, among others. In 2014, 61 percent of drug overdose deaths involved some type of opioid.

Fast forward to 2018 and there’s no longer a major push for narcotics. In fact, the topic of conversation is the exact opposite.

In late April, Dr. Bundschu and the roughly 1,000 doctors in attendance at the American Academy of Pain Medicine’s annual meeting in Vancouver, Canada listened to in-depth discussions on the opioid epidemic plaguing the U.S. and the importance of now keeping patients off narcotics whenever possible.

Themed “Managing Acute and High-Impact Chronic Pain Through Multidisciplinary Care”, the conference addressed the challenge of balancing the need for improving comprehensive pain care while responding to the growing societal epidemic of prescription opioid abuse and opioid-related overdoses and deaths. Through the presentation of more than 30 hours of pain medicine education from expert faculty around the country, this year’s annual meeting was designed to provide physicians with the skills and knowledge necessary to improve patient care and optimize patient outcomes.

“I’ve been doing this for so long that it causes you to pause and reflect,’” says Dr. Bundschu, who attends two to three national meetings a year as a lecturer, presenting data on research he’s done, or as an attendee. “Getting people off opioids was a big topic of conversation. It makes you ask yourself how did we get here and how do we fix it?”
For patients living with long-term pain associated with cancer, HIV and arthritis for which there is no cure, the question becomes how do you tell a patient who can longer get out of bed or accomplish simple daily tasks, such as washing the dishes, that you can no longer give them pain medication because of the potential repercussion?

Since 1999, opioid pain reliever prescribing has quadrupled and has increased in parallel with overdoses involving the most commonly used opioid pain relievers, according to the CDC. In 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication — enough for every adult in the U.S. to have their own bottle of pills.

“Part of our job is to be Mother Teresa and the other is to be Sherlock Holmes,” he says. “It’s our responsibility to make sure our patients are taking their medication appropriately. That’s part of our job, too.”

In an effort to reverse the epidemic of opioid drug overdose deaths, the CDC issued guidelines in 2016 for prescribing opioids for chronic pain in an effort to encourage doctors to prescribe pain medications responsibly.

In June 2018, the National Institutes of Health (NIH) launched its Helping to End Addiction Long-Term (HEAL) initiative. This new initiative, funded by Congress, was created to provide scientific solutions to the national opioid overdose crisis, including improved treatment strategies for pain and opioid use disorders.

“I have a lot of elderly patients who take one to two Percocet a day,” says Dr. Bundschu. “That’s what allows them to get through their day. There’s a place and time for everything. You have to be very astute to the signs of addiction, overuse and divergency. That’s how we stay out of trouble by confirming our patients are taking what they are supposed to be taking.”