Chad Ryan | The Journal Gazette Amy Harmeyer, an intensive care nurse who is studying to be a nurse practitioner, is being taught to deal differently with patients’ pain as the medical profession nationally and in northeast Indiana confronts an epidemic of opioid addiction.
Sunday, December 04, 2016 8:19 am
Fighting pain with knowledge
When she was in nursing school, Amy Harmeyer was taught that pain is the fifth vital sign. Harmeyer, now a registered nurse who works at Parkview’s ICU, points out that hospital patients are asked to rate how well their pain has been managed as part of a standard federal treatment-assessment questionnaire. The fear, Harmeyer said, is that hospitals that don’t show up well on the pain questions won’t be reimbursed by Medicaid or Medicare.
But there’s a growing realization among medical professionals that controlling pain by prescribing opioids too freely helped create the drug crisis we face today.
Now, preparing to be a nurse practitioner at the University of Saint Francis, Harmeyer is seeing dramatic changes.
"Pain as the fifth vital sign is going away," Harmeyer said. Those Centers for Medicaid and Medicare Services questions such as, "How often did the hospital or provider do everything in their power to control your pain?" are being rewritten (though CMS contends that reimbursement decisions were never predicated on pain management assessments). And Harmeyer is being taught to deal differently with people who are suffering.
She will be able to prescribe opioids when she becomes a nurse practitioner in 18 months, but they may not be the first alternative. "Chiropractic, acupuncture, guided imagery and using distraction" are among the pain management strategies she’s learning to consider.
Harmeyer is already on one of the front lines in the war against drugs, dealing with an increasing number of overdose victims who are brought in to Parkview.
Soon, Harmeyer may be on the other end of the treatment process, possibly treating addicts who need other drugs to kick heroin. And she will be weighing whether to give opioids to patients in pain.
"It does make me nervous," she said last week. "Sometimes you have to just tell people, look, I don’t feel comfortable prescribing this for you. You just have to be upfront and have the conversation about the risks."
Wendy Clark, who runs the Saint Francis nurse-practitioner program, brought Harmeyer and many of her other students to the screening of a two-hour documentary and forum on Indiana’s opioid problem at WFWA last month.
The documentary was a chronicle of Hoosier lives destroyed and families devastated by the opioid epidemic. But the second hour was full of hope, as a parade of local health and social service experts enumerated the ways people could get help and emphasized that drug addiction is a disease to be treated, not a crime to be punished.
"I call it the accidental epidemic," said Allen County Health Commissioner Deborah McMahan.
"In the late ’90s, there was a study that revealed that physicians were not really doing a good job of controlling terminal pain in patients, and we all tried to do better," she said. "As we tried to do better, we were prescribing more opioids and other types of medications to help ease the pain.
"As we prescribed more, they produced more, and as they produced more we prescribed more, until the point at which we just really began prescribing them pretty liberally for a lot of people, not only for acute pain but for chronic pain."
A few years ago, about when drug deaths began to surpass auto accidents as the cause of deaths in Indiana, medical professionals began to realize that prescription opioids were far more addictive and dangerous than they had been taught.
"We just didn’t know," McMahan said. "We just did not realize the impact that these medications really had."
"We didn’t understand the seriousness when we were being educated," Clark said after the program. ‘‘We thought we were treating the symptom of pain but weren’t understanding the changes that were occurring in the brain simultaneously."
Students like Harmeyer are getting a different kind of education. The more cautious approach on opioids is a focus of Saint Francis’ advanced pharmacology course and infuses the whole curriculum, Clark said.
This new wave of awareness is sweeping other medical and pharmacological training programs as well. It is moving schools to offer drug-specific health training for students. It is changing law-and-order lawmakers into compassionate advocates for fewer prison sentences and more drug-treatment programs. As Brian Francisco reports today, it may even move this year’s glacially stalemated Congress to provide more resources.
It is empowering emergency workers and even family members to save opioid overdose victims from death by injecting them with a powerful antidote called naloxone. And it has helped our state and more recently our county to overcome the tendency to balk at giving heroin addicts clean needles to slow the spread of HIV and hepatitis C.
People are still suffering and dying in our community and around Indiana. Though the floodgates of prescription painkillers are being slowly brought under control, heroin – much of it tainted with even more volatile synthetic opioids – has rushed in to fill the void.
But growing armies of doctors, nurses, pharmacists, police, lawmakers, educators and ordinary citizens are rising up to fight this plague.
It has been almost five months since our series on the opioid problem began. And this is a story no one can walk away from.