"Sometimes opioids are appropriate for chronic pain," Dr. Halena Gazelka said. It was a polite lead-in for the truth bomb she was about to drop next. "It's a rare situation that they are appropriate."
The comment came near the close of a panel discussion convened in Rochester earlier this week to discuss the opioid crisis, a meeting of minds among area stakeholders from social services, law enforcement and medicine, and one that underscored the challenges still remaining in reversing years of misleading messages about the pills' safety for long-term use.
Gazelka is the director of the Mayo Clinic Opioid Stewardship Program. She is one of numerous clinicians who took part in the recent three-part TPT-Mayo Clinic documentary, "The Opioid Fix," and was responding to the position asserted by panel moderator Betsy Singer that nothing about the film should be taken to diminish the notion that opioids are effective and appropriate in the treatment of chronic pain.
"We know there a lots of good reason for patients to be weaned off of opioids," Gazelka countered, "even if they have medically complicated forms of chronic pain. That's where we need education for patients and providers. Education that there are other pain management strategies available. That the [Mayo Clinic] Pain Rehabilitation Center offers behavioral therapies. That there are interventional programs for pain and other medications patients can take for pain. So I think that while we'll continue to always use opioids ... the default should not be opioids."
Moments earlier the audience had watched a segment from the documentary in which Gazelka described the clinic's systematic efforts at stemming overprescribing internally.
"We found that 65 percent of the opioids prescribed by Mayo Clinic were going unused," she said of the project. "We went to each surgical practice specialty and got them reduced by half. Just here in Rochester, that's over a million less pills of oxycodone each year."
Twin Cities Public Television Executive Producer Steve Simon directed the documentary. He told the audience the film came about through a chance encounter between representatives of the clinic and TPT after an airing of the Ken Burns documentary on Mayo Clinic in 2018.
"Something that haunted me from the beginning," Simon offered, "was that the United States has five percent of the world's population and 80 percent of its opioid dependency. Why is the most powerful, wealthy country in the world in so much pain?"
Taking a million opiates out of circulation has stimulated the regional market for illicit opioids, as Rochester Police Department Capt. John Sherwin told the gathering, including rising trade in heroin and illicit fentanyl. Sherwin said officers in Rochester all carry Narcan and have made 40 administrations of the life-saving rescue drug.
"The things that we've been doing in the past don't work," he said of the RPD Recovery Assistance Program, an effort to engage officers in referring persons with addiction to area resources. "In the mid-90's it was lock them all up. Well, that didn't work. We're at a point where we have to be creative and try something different. We're not going to arrest our way out of this problem."