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To Your Good Health: Balancing chronic pain needs and risks of opioid prescription

By KEITH ROACH, M.D.

DEAR DR. ROACH: The new laws concerning prescription of opioids, especially the requirement of three-day or seven-day prescriptions, has caused quite a disruption in our area, causing some doctors to take early retirement. Doctors should decide how long to treat patients. There are people who could get liver failure taking Tylenol or overusing aspirin. The drug overdoses are young people using street drugs like heroin or fentanyl. What do you say? — C.G.

ANSWER: Fatal overdoses from many different drugs have risen dramatically over the past 20 years. All deaths from overdose are tragedies, and it’s certainly appropriate to try to find ways of reducing these deaths. There is absolutely a risk that people who need opioids for long-term chronic pain are having increased difficulty getting them. Not everyone benefits from long-term use of opiates, but there are people who use them appropriately and effectively. An expert should be consulted in these cases.

Prescription opioids are the cause of roughly 25% of fatal overdoses. Reducing UNNECESSARY prescribing of these drugs is likely to reduce the number of people becoming dependent on the drugs. A 30-day prescription for a painful condition expected to last only a few days is a mistake with potentially profound consequences. However, excess restriction on prescriptions for the subset of people with chronic pain who benefit from long-term opiates could cause the difficulties you mention in addition to letting terrible pain go unrelieved.

Since 2015, the largest single cause of overdose deaths has been illegal synthetic opioids, especially fentanyl, although both heroin and prescription opiates continue to kill increasing numbers of people. The solution to the problem of illegal fentanyl is elusive and well beyond my expertise. However, many of those using illegal opioids got their addiction from legal opioids, which is why casual prescribing of large amounts needs to stop.

Policies on prescription opioids require flexibility to allow physicians to prescribe long-term opiates appropriately while still cutting down on unnecessary prescriptions. Physicians who prescribe these drugs are obliged to do so safely and effectively; otherwise, they shouldn’t be prescribing them.

We need to work together to reduce all overdose deaths, whether they are from prescription or street drugs. Opiate addiction is preventable and treatable in most cases. People who recover from opiate addiction get their lives back, which is good for everyone.

DEAR DR. ROACH: Could you tell me what causes small boils all over the head? They are very painful. — L.D.S.

ANSWER: Skin infections are caused most commonly by Streptococcus (“strep”) and Staphylococcus (“staph”) species. As a general rule, if it has pus, it’s staph; if not, it’s strep. These organisms live on the skin and can cause infection where there are breaks in the skin. Even microscopic breaks allow the bacteria to enter. When there are many areas of infection on the scalp, the concern is that the hair follicles are the location of the infection. A clinical exam can confirm this.

Sometimes, the follicles get damaged by something you are doing. Frequent scratching or pulling on hair, tight hairstyles and some hair care products can predispose to developing folliculitis of the scalp. Some scalp conditions, such as eczema, can predispose to scalp infections. A dermatologist would have the most expertise at looking for underlying hair or scalp conditions.

Local treatment, including warm compresses, anti-dandruff shampoo or antibiotic creams may resolve the problem. However, oral antibiotics are sometimes necessary.

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