The Opioid Crisis and Hand Therapy

Posted by Camerion Judge, MS, OTR/L, CHT 04/12/2018

On October 5, 2017, members of four federal agencies belonging to the Department of Health and Human Services (HHS) testified before the Senate Health, Education, Labor and Pensions (HELP) Committee. Those agencies – SAMHSA, CDC, NIH, FDA – purposed to outline the Federal Response to the opioid crisis, a crisis where resolution seems to be elusive, yet workable thru continued agency commitment and funding.

For fiscal year 2018, a budget of $500 million was requested by the Trump administration. In March 2018, the omnibus bill added $3.3 billion to the final equation, with the above agencies taking their cut, as well as another four federal administrations/departments (VA, DOJ, HRS, ACF). Despite the greatness of both this budget and the supported endeavors, the budget amount is criticized as being inadequate. The scope and magnitude of costs, related to combating what is being called one of the worst public health crisis in U.S. history, is even greater.   

How did we get here? Within the HHS’s testimony is criticism of the prescribing practices in the mid to late ‘90s, as well big pharmaceutical companies’ lack of disclosure, or ignorance, of the potential for abuse, addiction or overdose of opioid-base medications when prescribed in higher doses and for long durations. Statistics for the last 15 years in opioid abuse-related deaths show a steady, sharp incline, with the latest reported number of deaths at least 64,000 for 2016 alone – the highest number ever recorded.

What can we do as therapists? As health practitioners, we share the burden and the privilege of being on the front lines of public awareness, prevention strategy and alternative pain management promotion. As we work with and develop relationships with our patients based on trust and sincerity of spirit, we can dig into our treatment tool bag, and access those parts of our education that include mental health, pain management and evidence-based treatments. To this endeavor, we must find alternative or complimentary pain management strategies. This begins with accurate monitoring and reporting of pain, and one such tool supported by the NIH is the Patient-Reported Outcomes Measurement Information System (PROMIS). According to NIH, it is a rigorously tested outcomes measurement tool used to measure pain, fatigue, physical functioning and emotional well-being.

In addition, we have the responsibility to effectively communicate with our medical and allied health partners, and advocate on behalf of the patient or client in our charge. An interview of a fellowship-trained hand surgeon, Dr. Philip To, practicing in Scottsdale, AZ, gives a little more insight into the opioid crisis, the effect on post-surgical care and how the practicing OT or PT hand therapist may better partner in combatting the epidemic at hand. Please, look forward to this interview as Part 2 to this update. The following questions will be asked of Dr. To:

From your perspective as a hand surgeon, are you seeing proof of an opioid crisis?
What kind of impact has the potential for opioid addiction among your patients had on your practice?
Have you found empirically that your patients, especially those post-operatively, are inherently capable of effective pain control?
Have you found evidence of alternative, non-opioid medication as effective in assisting patients in pain control?
What is your proposed strategy for curbing our current opioid epidemic?
How do you feel the role of the hand therapist may assist in this strategy?

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