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member of the Board of Directors of the American College of Emergency Physicians Board of Directors ; and co-chair of the Emergency Department Sickle Cell Care Collaborative .
Many of the behaviors physicians are taught to view as “ red flags ” do not necessarily apply to patients with SCD .
For example , Dr . Kavanagh recalled that she was told in medical school that a patient who comes in asking for a specific
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medication at a specific dose may be an addict . “ But people with SCD are educated about what medication works for them and at what dose , because they have needed these medications most of their lives ,” she said .
Racial stereotypes can further stigmatize people with SCD . Dr . Clauw admitted that , during his residency , he often would not believe the descriptions of pain in that patient population for three reasons .
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“ First , because I was white and they were black and that created a tension with respect to unconscious bias . Second , the pain they exhibited was almost unbelievable .” He recalled seeing patients who would scream out simply from having a bed sheet put over their legs .
The third reason was that , at the time , he did not fully understand their pain . “ I thought they were faking because I did not know about opioid-induced hyperplasia ,
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or the biologic mechanisms that allow the brain to ‘ turn up the volume ’ on the nerves throughout the body ,” he said .
Minimizing Misuse
The legitimacy of their pain does not mean that patients with SCD or cancer are immune to opioid addiction .
“ Years ago , the concept was propagated that the risks of opioid addiction were lower if one was treating ‘ true ’ pain , but that has not been biologically proven ,” Dr . Brandow said , adding that “ the rate of addiction in patients with SCD is no higher than that of other populations .”
A recent study showed that use of opioid prescriptions was more common in cancer survivors than in individuals without a history of cancer , even 10 or more years after a cancer diagnosis . 9
Commenting on the results of that study , a co-author said that physicians providing primary care to cancer survivors should question the reasons for long-term , continued opioid use to differentiate between ongoing chronic pain and dependency . ( For more advice on mitigating the risk of opioid abuse and misuse among patients with cancer or SCD , see the SIDEBAR on page 60 .)
Many states require clinicians to review their state ’ s prescription drug monitoring programs to determine how many opioid prescriptions have been filled by a particular patient in the past 30 days , who prescribed the drugs , what dosage and type were prescribed , and other information .
“ Every time we prescribe an opioid at the Medical College of Wisconsin , we are required to look in our database to see the patient ’ s history , if they have obtained opioids , by whom , and how much ,” Dr . Brandow said . “ If I find out that a patient has been to multiple EDs between that day and our last visit , it does not automatically mean he or she is an addict . But having this information allows me to ask why he or she is seeking care elsewhere and how we can return to me being the sole provider of their pain medicine .”
Minimizing the risk for abuse will require time and effort from all involved parties , Dr . Hirshon said .
“ We need to acknowledge our role and take responsibility to come up with ways to help people ,” he said . “ We need better patient-provider communication so that we can appropriately support and understand each other .”
There is a delicate balance between protecting people from the harms of opioids and ensuring they get the treatment they need when they are suffering from pain , Dr . Brandow said .
“ We can ’ t ignore this crisis , but it has to be addressed with the right people at the table ,” she said . “ As
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