Medical Students Say Their Opioid Experiences Will Shape How They Prescribe

Nov 26, 2019
Originally published on November 26, 2019 7:33 am

When Matthew Braun gets out of medical school, he'll be able to prescribe opioids.

A decade ago, he was addicted to them.

"The first time I ever used an opioid, I felt the most confident and powerful I'd ever felt," Braun says. "So I said, 'This is it. I want to do this the rest of my life.' "

Opioids took away his anxiety, his inhibitions, his depression. And they were easy to get.

"I just started breaking into houses," Braun says. "I found it amazing how trusting people were in leaving windows open and doors unlocked, and I found a lot of prescriptions."

Vicodin, OxyContin, tramadol. The drugs were everywhere. At the time, more than a decade ago, doctors and dentists were writing lots of prescriptions — even to Braun.

"I didn't need 20 Vicodin when I got my wisdom teeth out," he says. "So I just saved them."

Braun, who hasn't used opioids in years, is now a first-year medical student at Pacific Northwest University of Health Sciences in Yakima, Wash. He told his story at a two-day summit on opioids held in Yakima.

One goal of the event was to get past the angry rhetoric that often surfaces in discussions of opioids.

"It can get very hostile," says Edward Bilsky, a pain researcher and the university's provost and chief academic officer.

Bilsky has heard people in the addiction community blame chronic pain patients for opioid overdoses. The logic is that widespread use of opioids for pain has fueled addiction and abuse.

"And on the flip side," Bilsky says, "pain groups are saying, 'No, it's [people in the addiction community] that abuse these drugs, and now I can't get access to something that did give me some semblance of quality of life.' "

Bilsky says the summit was designed to help the pain and addiction communities acknowledge common barriers — such as stigma and access to care — and encourage them to work together to find solutions.

So in addition to people like Braun, who has experienced addiction, the event included people like Katie Buckman, a third-year medical student at the university who gets severe migraines.

Katie Buckman, a third-year medical student at Pacific Northwest University of Health Sciences, gathers supplies for her volunteer work at the Yakima Union Gospel Mission's medical clinic.
Jovelle Tamayo for NPR

"It feels like your head is going to explode," Buckman says. "And on top of that, you can't tolerate light, and the nausea and vomiting — you're just miserable."

Migraines almost forced Buckman to leave medical school. But she has been able to continue with help from a primary care doctor who understands the severity of her pain.

"If I'm lucky enough to have the migraine between Monday and Friday from 8 to 5," she says, "I can call him and get a shot of Demerol," which is an opioid.

That's rare, Buckman adds. Her migraines have largely disappeared since she started on a new preventive drug a few months ago. When they do crop up, her usual remedy is Benadryl and fluids.

But Buckman still remembers the stigma that pain patients can face when they show up in a hospital's emergency department.

"One time I had a doc, before he even came in and introduced himself as my caregiver, he just popped his head in, said, 'Well, you're not going to be receiving any narcotics today,' " Buckman says.

Then there are doctors like Tom Eglin, an emergency physician who also participated in the opioid summit.

Eglin is a faculty member at the university and works at Virginia Mason Memorial hospital in Yakima. So he knows what can happen to drug users who take a powerful opioid like fentanyl thinking it's something less potent.

"They go into respiratory arrest," he says. "And if they're lucky, [a first-responder] has naloxone and can reverse that."

But Eglin also sees patients who clearly need an opioid. They may have excruciating pain from a kidney stone, a fracture or a bad burn.

"Pain is the primary reason that people come to the emergency department," he says. "A typical night we're always writing prescriptions for pain medications."

The big challenge for an emergency physician is deciding whether a patient with no detectable injury is seeking drugs, Eglin says.

"Pain is the primary reason that people come to the emergency department," says Tom Eglin, an emergency room doctor and faculty member at Pacific Northwest University of Health Sciences.
Jovelle Tamayo for NPR

"Sometimes it's obvious," he says. "But the majority of the time, it's not just difficult — it's impossible."

Disabling back pain, for example, often occurs in patients with normal X-rays and CT scans.

And maybe, Eglin says, looking for drug-seeking behavior isn't a doctor's most important job when someone comes to them in distress.

"I try not to make that judgment," Eglin says. "Whether they're addicted or whether they're a migraine sufferer, they are still there for pain relief. And most people who are addicted still have the perception of bad pain."

What's frustrating, Eglin says, is that even when patients end up in the emergency room from an overdose, there's no easy way to get them into a treatment program. "Most of the time they get discharged to the street," he says.

People addicted to opioids and people in chronic pain have a lot in common: Both groups face stigma, often struggle to get treatment and need doctors who understand their problem.

That's a lesson medical students Buckman and Braun have embraced.

Once she's a doctor, Buckman says, "I'll be able to empathize at a different level because I have experienced severe pain."

First-year medical student Matthew Braun (right) studies for an anatomy exam with classmates Jeremy Hinton (left) and Jon Hagan.
Jovelle Tamayo for NPR

And Braun says his own history of addiction will help him treat people with that condition.

But even someone in recovery may need an opioid for certain types of pain, he says, adding that he'd write a prescription if it were appropriate and the patient was taking active steps to avoid relapse.

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STEVE INSKEEP, HOST:

The opioid crisis has put doctors in a tough spot. When they prescribe drugs like oxycodone or fentanyl, they risk contributing to addiction; when they don't do that, patients in pain may suffer. A medical school in Washington state wants to help future doctors decide what to do. NPR's Jon Hamilton reports.

JON HAMILTON, BYLINE: When Matthew Braun gets out of medical school, he'll be able to prescribe opioids, but as a teenager, he was addicted to them.

MATTHEW BRAUN: The first time I ever used an opioid, I felt the most confident and powerful I'd ever felt. So I said, this is it, and I want to do this the rest of my life.

HAMILTON: Opioids took away Braun's anxiety, his inhibitions, his depression, and they were easy to get.

BRAUN: I just started breaking into houses. And I found it amazing how trusting people were in leaving windows open and doors unlocked. And I found a lot of prescriptions.

HAMILTON: Vicodin, OxyContin, tramadol - the drugs were everywhere because at the time, doctors and dentists were writing lots of prescriptions, even to Braun.

BRAUN: I didn't need 20 Vicodin when I got my wisdom teeth out. So I just saved them.

HAMILTON: Braun stopped using more than a decade ago. Now he's a first-year medical student at Pacific Northwest University of Health Sciences in Yakima, Wash. And he brought his story to a summit on opioids held at the university. Ed Bilsky is a pain researcher and the university's provost. He says one goal of the event was to get past the angry rhetoric.

ED BILSKY: It can get very hostile.

HAMILTON: Bilsky has heard people in the addiction community blame pain patients for deaths caused by an overdose.

BILSKY: And on the flip side, pain groups are saying, no, it's you that abused these drugs, and now I can't get access to something that did give me some semblance of quality of life, and now it's been taken away.

HAMILTON: So Bilsky had a question.

BILSKY: How do we get them, instead of blaming each other for the conditions that they're in, acknowledging that they have these similarities and these barriers that they face and working towards solutions together?

HAMILTON: Step 1 - make sure groups listen to each other. So in addition to people like Braun, the summit included people like Katie Buckman. She's a third-year medical student who gets severe migraines.

KATIE BUCKMAN: It feels like your head is going to explode and, simultaneously, for me, someone is stabbing me in my right temporal area. And on top of that, you can't tolerate light, and the nausea and vomiting is just - it's - you're just miserable.

HAMILTON: Migraines almost forced Buckman to leave medical school, but she's been able to continue with help from a primary care doctor who gets her situation.

BUCKMAN: If I'm lucky enough to have the migraine between Monday and Friday from 8 to 5, I can call him and get a shot of Demerol.

HAMILTON: An opioid. That's rare, though. Buckman's usual remedy is Benadryl and fluids. And her migraines have largely disappeared since she started on a new preventive drug a few months ago. But Buckman still remembers times when she was treated with suspicion when she showed up at the hospital.

BUCKMAN: One time, I had a doc, before he even came in and introduced himself as my caregiver, he just popped his head in - said, well, you're not going to be receiving any narcotics today. Those are contraindicated in migraines.

HAMILTON: Then there are doctors like Tom Eglin, another participant in the summit. Eglin is a faculty member at the university and works in the emergency department at Virginia Mason Memorial Hospital. So he knows what happens to drug users who take fentanyl, thinking it's going to be something less potent.

TOM EGLIN: They go into respiratory arrest. You know, if they're lucky, somebody or EMS, you know, has naloxone and can reverse that.

HAMILTON: But Eglin also sees patients who need an opioid. They may have a kidney stone, a fracture or a bad burn.

EGLIN: Pain is the primary reason that people come to the emergency department. A typical night - we're always writing prescriptions for pain medications.

HAMILTON: Eglin says the hard part is knowing whether a patient with no detectable injury is seeking drugs.

EGLIN: Sometimes it's obvious. But the majority of the time, it's not just difficult; it's impossible.

HAMILTON: And Eglin says that may not be the most important point.

EGLIN: Whether they're addicted or whether they're a migraine sufferer, they're still there for pain relief. And most people who are addicted still have the perception of bad pain.

HAMILTON: Eglin says people addicted to opioids and people with chronic pain have a lot in common - they face stigma, they often struggle to get treatment, and they need doctors who understand their problem. That's a lesson medical students Katie Buckman and Matthew Braun have taken to heart. Buckman says her experience with migraines will make her a better doctor.

BUCKMAN: I'll be able to empathize at a different level because I have experienced severe pain.

HAMILTON: And Braun says his own history with addiction will help him treat people with that problem. But he says even someone trying to stay away from drugs may need an opioid for certain types of pain.

BRAUN: My mom actually asked me a question recently. It was about, would you prescribe an opioid to a person in recovery? I very quickly said yes.

HAMILTON: A qualified yes. Braun says the prescription would have to be appropriate, and the patient would need to be taking active steps to avoid relapse.

Jon Hamilton, NPR News.

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