Program focuses on chronic pain – The Daily Reflector



By Michael Abramowitz

Sunday, December 15, 2013


Physicians and other health care professionals agreed on Thursday that something must be done to curb the rate of accidental overdoses and deaths caused by drugs prescribed for chronic pain management, particularly among Medicaid patients.

They also agreed that the problem is not going to be easy to solve.

A step toward a solution brought together Community Care of North Carolina, The Chronic Pain Initiative of Project Lazarus, Pfizer Pharmaceutical and the Governor’s Institute on Substance Abuse for an informational program on Chronic Pain Management at The Eastern Carolina Heart Institute at East Carolina University to engage attending health care professionals in a conversation about the issue.

The immediate goal was to demonstrate to local care providers that better communication and the use of a wide range of available new approaches to pain management could effectively reduce incidences of harm caused by improper or poorly managed medication use.


Dr. Tom Wroth, a primary care doctor affiliated with Community Care N.C., the state’s nonprofit Medicaid management entity, led the discussion among about 75 primary care and emergency physicians and nurses, pharmacists, pain specialists, substance abuse treatment and behavioral health providers, and representatives from the Pitt County Sheriff’s Office.


Death by accidental drug overdose now is the leading killer among the state’s population age 25-44 years, according to Department of Health and Human Services statistics, health officials said.


The North Carolina Medicaid population experiences a much higher rate of overdose deaths than the North Carolina population, according to DHHS figures. A recent department study suggested that fatal overdoses among the Medicaid population are associated with claims for mental health disorders, substance abuse, and routine medical care for pain management.


“It’s difficult for me and these doctors to take care of these patients with complex conditions who constitute about 20 percent of the state’s population,” Wroth said. “The epidemic of accidental overdoses occurring in the state shows that we’re causing harm by putting so many pills out there that people are dying.”


The combination of the complex care issues and poor results doctors are getting is causing physician burn-out and a serious public health problem, Wroth said. The attitude among many physicians seems to be toward discharging difficult patients from their care or transferring them elsewhere, Wroth said. He hopes that arming them with better tools and more effective methods will change that approach.


“Meetings like this are the beginning steps in trying to improve this situation,” he said. “Out of the chaos of these big problems, the small steps like these meetings will lead to solutions.”


“Maybe some providers will feel more competent about taking care of some of (their patients’) problematic behaviors and getting (patients) back on track, rather than discharging them from their practice and burdening other physicians in the community,” Wroth said.


Some tools offered by Project Lazarus experts could be a way for medical practitioners to simplify the evaluation process and share responsibility for care coordination among doctors, patients and other community-based care providers. The project is a public health nonprofit organization established in 2008 in response to the state’s extremely high drug overdose death rates.


Lazarus staff work with those in the CCNC Chronic Pain Initiative to help deliver better pain relief while reducing overdose risk. They provide tools including care agreements between physician and patient that detail a prescribed course of care, including closely monitored prescription pain medication regimens.


The initiative also outlines a process for care providers to closely record and communicate to each other what actions have been taken, including prescription histories and outcomes.


Community Care N.C. is part of the overall Medicaid system that is being reviewed by the McCrory administration and DHHS as they plan for managing that population’s needs and costs. Programs like the Chronic Pain Initiative should not be affected by any changes to the larger system, Wroth said.


“This is still going to be a high-risk and high-cost population, so I think we’re going to be dealing with the issue no matter what model we have,” Wroth said.




Contact Michael Abramowitz at or 252-329-9571.


via The Daily Reflector.