House Calls

WIN 2019

House Calls Magazine is a quarterly publication that focuses on health and wellness. It includes a wide assortment of articles with topics on the latest health and wellness information, nutrition, safety, lifestyles, and more.

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In recent years, that paradox has tipped heavily in the wrong direction. In the late 1990s, skyrocketing opioid prescriptions led to a wave of misuse and addiction among patients. By 2013, the problem had coalesced into a full-blown crisis of epidemic proportions. According to the Centers for Disease Control and Prevention (CDC), an estimated 350,000 Americans died from opioid-related drug overdoses between 1999 and 2016. Addiction and overdose have touched every community—and most people—throughout the country. For many, the path to opioid addiction starts with prescription pain medications such as codeine or oxycodone. Because the medical community mediates access to these legal opiates, doctors across the country—and here in the Lowcountry—are considering how they can help address the opioid crisis by reducing the use of these highly effective, yet highly addictive, medicines. "As the gatekeepers, it's our responsibility to limit their use if we begin to see misuse," says Roper St. Francis Healthcare affiliated bariatric surgeon Dr. Kenneth Mitchell. "We bear that responsibility, and therefore are responsible for making a difference." Yet every day, patients here and across the country undergo bariatric operations, joint replacements, and other procedures for which pain medication is often indicated. Additionally, chronic pain still afflicts more than 40 percent of older adults in the United States. So how do doctors reconcile patients' need for serious pain relief with the epidemic at hand? "There has been a comprehensive shift in the way we manage acute and chronic pain," explains Roper St. Francis affiliated anesthesiologist Dr. Jeffrey Frohock, who serves as lead physician for the Roper St. Francis pain management and opioid reduction team. While these strategies represent a new way of thinking, they're a largely back-to-basics approach—from the careful use of familiar drugs like Tylenol to a focus on lifestyle interventions—and the outcomes speak for themselves. OPIOIDS DEFINED "Opioids are any type of natural or synthetic variation of a drug derived from opium," explains Dr. Frohock. "And what opioids do really well is quickly reduce the severity of pain." Where medicines such as acetaminophen, or Tylenol, can take half an hour to kick in, opiates can take effect in mere minutes. For a suffering patient, near-immediate pain relief can be a boon well worth side effects such as nausea and constipation. Of course, opioids come with other side effects, too: a mild high and a surge of euphoric feeling, which can be addictive. The drugs work by binding to proteins called mu receptors throughout the brain and body, blocking pain messages and telling the brain to relax. They also trigger the production of dopamine, activating a reward pathway that makes the brain perceive the opioid as both 24 { winter 2019 } h o u s e c a l l s P H O T O G R A P H ( D R . F R O H O C K ) C O U R T E S Y O F R O P E R S T . F R A N C I S H E A L T H C A R E Dr. Jeffrey Frohock A little more than 200 years ago, a curious pharmacy apprentice isolated morphine crystals from opium for the first time. Friedrich Sertürner's discovery of morphine was little appreciated during his lifetime, and he died addicted to the drug he'd created. Sertürner's own story is reflective of the paradoxical nature of morphine: it—and all of the opium-derived drugs, or opioids, that have followed—made much of modern medicine possible. At the same time, the drugs' highly addictive character has cost countless human lives and created a current medical crisis. Opioid overdose deaths in South Carolina have risen each year since 2013, reaching 748 deaths in 2017. Charleston, Horry, and Greenville Counties typically report the state's highest numbers. South Carolina falls in the middle of the pack for deaths from opioid overdose by state, with roughly 13 per 100,000 residents annually.

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