Opioid crisis part 2, the medical provider’s point of view

By Moira Blazi

Modern medicine has triumphed over pain. Research scientists have discovered how pain is processed in the brain and how to stop it. It is truly one of the blessings of living in America today, that you can have a reasonable expectation of never having to endure prolonged severe physical pain, no matter how extreme the injury, disease, or infection.
Here in Libby, opioid based pain-relieving drugs are both readily available, and widely abused. They go by names like Vicodin, Percocet and Lortab. They fool the brain into believing that there is no pain. According to the Centers for Disease Control (CDC), for every 100 Montanans, there are 83 opioid painkiller prescriptions written.
“Over the last few years, we have cut back.” (on opioid prescriptions), said John Thornton RN, and emergency room manager at Libby’s Cabinet Peaks Medical Center. “We are following current CDC guidelines recommending non-narcotic pain killers across the board, and we are focusing on a smaller amount,” Thornton said.
Most Hydrocodone or Oxycodone pain relievers are used as they are intended, to relieve acute pain due to injury. Some, however, are used to relieve other kinds of pain.
“Opioids don’t fix anything, patients have to do that themselves,” said local chiropractor, Dr. Scott Foss.

Foss should know, his professional focus is not just alleviation of pain, but creation of well-being, something Dr. Foss believes involves mind and spirit as well as body, but which has a lot to do with chemicals in the brain, namely dopamine. Dopamine is produced naturally and is responsible for creating feelings of pleasure or happiness.
“Most people think of pain as purely a physical thing,” Dr. Foss said, “but that’s wrong, I’m saying that pain is a sign that stress psychology is present.”
Pain stresses the body, and when a person is in pain and lost or has no ambition, they have no way to stimulate the body’s natural dopamine production.
Like many physicians and health practitioners, Dr. Foss aims to heal the mind as well as the body by encouraging his patients to set goals and keep them.
Kristin Koenig, Ph.D., would tend to agree. “We can elevate our own dopamine,” she told the Montanian. Koenig started a private practice after years of working at the now closed Mental Health Center. Many of the patients she now sees are struggling with opioid addiction.

“In general, this town has a huge problem with addiction,” she said, “as a society, we’ve become dependent on pills as a quick fix.”
“There is a reason people use substances to cope. They are chasing the state of feeling good. I try to help my clients find other ways to feel good, like writing a list of things they are grateful for. We pull the Band-Aid off and find out what’s broke. No matter how bad it gets, and, although sometimes it’s hard to find, there’s always something they can do,” she said.
Opioid medications do have legitimate, sometimes essential uses though. “Broken or crushed bones, gunshot wounds, and acute muscle strains are some of the most common reasons for dispensing these medications,” said Thornton.

It’s a tough balance to achieve, helping patients control severe pain while not prescribing too much opioid pain medication for too long. Many primary care providers no longer manage chronic severe pain. Referrals to special pain management clinics are now commonplace. Pain clinics, like Kalispell’s Center for Wellness & Pain Management now offer addiction medicine, medical pain management and an array of alternatives to opioids such as acupuncture, counseling, massage and yoga therapies.

At the Northwest Community Health Center (CHC), pharmacist Liz Wolsfelt told the Montanian that she has not seen any increase of Hydrocodone and Oxycodone prescriptions in recent years. “We try to suggest lifestyle alternatives, and make sure all patients know how to store and discard their medication,” she told the Montanian. “Its about education, education, education.”
Still, sometimes abuse still occurs. Back in 2015, as many local residents may remember, Libby physician, Dr. Clyde Knecht had his medical license indefinitely suspended for overprescribing.
According to the Montana office of vital records, ”Since 2000 the rate of prescription drug overdose has doubled, with more than 700 deaths attributed to opioids alone.”
In February, 15 Senators, including Montana’s Jon Tester introduced the Opioid Response Enhancement Act in the U.S. Senate in hopes of finding help to fight the opioid epidemic.
“Opioid abuse is a scourge on our state and on our nation,” Tester said. “If we are going to get a grip on this crisis, we must give folks on the ground the tools they need to help prevent and treat addiction. Rural communities have been hit particularly hard by this crisis, which is why we’ve introduced this bill, to get resources where they need to be.”
If the bill passes, it may mean expanded access to medically assisted therapy such as Suboxone for addicts here in Libby.

“Addicts are not bad people, a lot of them are reluctant to tell you the truth,” Dr. Foss said to the Montanian. “Helping them is a slippery slope, and instead of judging, we take it slow.”
Smith said, ”It is our mothers, daughters, sons husbands and wives, and maybe even someone’s grandmother we are helping.”
Part three of this series will shine the spotlight on local opioid users and abusers their stories and solutions, effects on families and what happens when law enforcement becomes involved.
Anyone who would like to share their story with the Montanian, is encouraged to contact our office.