In the 1990s, Dr. Jim Shames was a family physician in private practice. And when patients came to him complaining of pain, like most other doctors, he’d often prescribe opioid painkillers.
“It made sense to everybody. It made sense to me. That’s the way I was practicing in the ‘90s,” Shames said.
Doctors were being pressured to provide more pain relief, according to Shames. Research papers, many funded by the pharmaceutical industry, contributed to a growing professional consensus that opioid painkillers were safe and should be used more liberally.
“When your state medical board says, ‘Hey docs, you need to be more compassionate about treating pain.’ When you go to the hospital and they say, ‘Don’t let people suffer with pain. Otherwise, we will look negatively upon your recertification.’ After awhile you’ve created an entire thought bubble that supports your point of view, and that’s where we have been for a while,” Shames said.
Shames reached a turning point several years after he became medical director for Jackson County Health and Human Services. In 2006, he said, the county medical examiner brought to his attention a stunning fact.
“‘Do you realize we have about one citizen a week dying from accidental overdoses in Jackson County?’ And I said, ‘I cannot believe those numbers. You’re going to have to show that to me,’” Shames said. “And we sat down in his office and we pulled file after file after file of people who died from prescription drug overdoses.”
Confronted with this grim toll, Shames started looking for ways to, as he put it, “turn off the spigot” of the opioid drugs that had become so ubiquitous. He formed the Opioid Prescriber Group and invited doctors and other health care professionals to develop new ways of treating their patients’ pain that don’t risk turning them into addicts.
He said the existing treatment model simply doesn’t work.
“You walk in, we close the door, we spend 15 minutes. You expect a pill, I expect to give you a pill, and out you go and everybody’s happy,” Shames said. “This requires something very different.”
Shames’ group has devised guidelines for appropriate use of opioids, based on research that suggests for most chronic non-cancer pain, opioids are not the best treatment.
The group has also developed alternatives to opioids that involve a range of practitioners, from physical therapists and mental health counselors to acupuncturists and yoga teachers. Shames said this is a new approach for most doctors.
“Whatever the modality is, whether it’s way out there in terms of what a physician is comfortable with or something that really resonates in terms of the therapy they’re used to, it’s got to be coordinated. And that’s where I think the difference is.”
Shames said many doctors are getting on board with the new approach. Others, not so much. But, he said, the numbers show the effort is making a difference.
“The most hard data you can look at is, who lives and who dies. We had 46 accidental overdose deaths in 2006. And we’re now down into the low teens or single digits.”
But it turns out there’s a perverse consequence of this success.
“The more successful we are at reducing the number of pills being prescribed, the more expensive they become on the black market. And the price of heroin’s just going down,” Shames said.
The result? What Shames called “a huge upswing” in overdose deaths from heroin. The irony is not lost on him.
“We’ve been concentrating initially on the upstream, which is, as I said, turning the spigot down,” he said. “But there’s a lot of downstream public health measures we need to take as well.”
Among those measures, Shames said, is making effective treatment available to those who got addicted by following their doctors’ orders. He said he still carries that sense of responsibility.
“I feel bad about it. I feel like I in a sense kind of pushed opiates on a number of people that would have much been better off without them,” he said.
This story is a part of Jefferson Public Radio’s series on heroin addiction in Southern Oregon, “Silent Epidemic: Addiction In Southern Oregon.” Read more at IJPR.org.