2017-05-18 / Front Page

Local doctor takes action against opioid epidemic

By Cindy Centofanti
Staff Writer • ccentofanti@mihomepaper.com • 989-269-9918

Dr. Babiker Dr. Babiker BAD AXE — Drug overdose is the leading cause of accidental death in the United States, 60 percent of those cases. One local doctor spoke about the many factors unique to this problem.

Dr. Yasir Babiker, who has practiced medicine abroad and now at Huron Medical Center, said he has seen his fair share of the opioid epidemic, but nothing comparable to how the United States prescribes narcotics and opioids.

Babiker practices Internal Medicine & Pediatrics at Huron Medical Center. He was a trained physician in other countries and here in Michigan. General internists are equipped to deal with whatever problem a patient brings - no matter how common, rare, simple or complex, and are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses are present.

“I was born in Sudan and I did training in East Africa and worked there for some time,” Babiker said. “I went to Dubai and worked there in internal medicine as well. Afterwards, I went to Ireland and the United Kingdom prior to coming to the United States.”

Babiker said his most memorable encounter with narcotics occurred within weeks of coming to Michigan: a 17 year old was emitted from the emergency room of the pediatrics ward with sickle cell.

“sickle cell is a painful crisis. It is anemia that can cause pain, so the nurse told me he needed a morphine pump and needed an order for it,” Babiker said “I replied to her and asked ‘Why do you think this boy needs that?’ to which she replied ‘That’s the rule,’ so, I insisted not to treat him with morphine.”

He said the incident became a “big problem” and they called the senior resident to overrule his decision and go ahead with morphine; Babiker felt it was the wrong thing to do.

“Because I worked in Sudan, there is a lot of sickle cell disease, and we just treat them with ibuprofen,” Babiker said. “In the United Kingdom, they treat you with ibuprofen and in the Persian Gulf Countries they treat you with ibuprofen.”

Babiker said it was astonishing to him how willing doctors in the United States are to write narcotic prescriptions for “practically anything.”

“Of course, the 17-year-old patient was treated with morphine and following that, he was given 50 pills of Norco, of which he received additional medication as needed every two-three weeks,” Babiker said while shaking his head.

He discussed the dangers of what is really hidden beneath the stigma associated with prescription drug and opioid abuse.

“Opioids are a very addictive substance because they work in your reward system in your brain,” Babiker said. He added that opioids are a type of narcotic pain medication and can have serious side effects if they are not used correctly.

When a patient has a mild headache or muscle ache, an over-the-counter pain reliever is usually enough to relieve the discomfort. But, if the pain is more severe, a doctor might recommend something stronger - a prescription opioid.

Most abused drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine, a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation and feelings of pleasure.

“After you use them, you will need to use them again, and over time, you will need more,” Babiker said. “That’s how the brain functions, after time you develop dependence both psychological and physiological. Eventually, you will not be able to stop taking it because it will have adverse effects, like affect your function.”

Babiker also said that someone who develops a dependence on opioids will eventually start looking to obtain it from other places such as “street drugs.”

The most common forms of illegal opioid narcotics are heroin, opium and any other medications taken outside the recommendations of a doctor’s prescription.

“Unfortunately, in the United States we consume almost 90 percent of opioids prescriptions in the world,” Babiker said.

He said no other country prescribes opioids as much as the United States does.

“The next is Canada,” he added. “The addictive problem is here in the medication. As for the medical field, it is highly overused and a lot of times for unjustified reasons. Opioids are good for shortterm pain, like a sprain in your back which may be helpful for two to three days, but beyond that there is nothing evident proving that it helps.”

Babkier said he thinks physicians and doctors who prescribe narcotics and don’t closely regulate their use play “a little role” in the epidemic, but shifted the focus onto a broader spectrum.

One of the main issues, he said, is physicians prescribe opioids for a longer duration than what is required. For instance, he said, if someone goes to an emergency room anywhere in the United States with a back sprain, the ER doctors might prescribe an opioid for two weeks. Babiker added, most of the time patients suffering from those types of injuries don’t need the medication for more than two days.

Babiker said there are two types of pain: acute and chronic.

Acute lasts a few days, if a patient fractures an ankle, he or she might need a strong pain reliever for two to three days, but eventually the pain will subside and an opiate is no longer needed after the three-day mark.

Chronic pain is pain that lasts a long time.

In medicine, the distinction between acute and chronic pain is sometimes determined by an arbitrary interval of time since onset; the two most commonly used markers being three months and six months.

Babiker said a patients are highly likely to become addicted when they take opioids every day for two weeks or longer when prescribed for chronic pain, because it is easy to become dependent.

He also said a physician cannot simply solve the problem by educating the patient, or overprescribing the patient, which he noted is the problem.

“In my practice, I do have some patients on narcotics, but we work to wean them off of the opioids and have managed to be successful,” Babiker said. He added he does not prescribe any narcotics for chronic pain ever and then explained why.

“We don’t have any science showing that prescribing an opioid for chronic pain helps the patient,” Babiker said. “Even after a few weeks it doesn’t numb the pain anymore, it only numbs your brain.”

“People assume that they should never have pain or if they have pain it should be completely controlled, and that is the wrong assumption which is very widespread (in the United States),” Babiker said.

Most of the time, patients have a wrong expectation when it comes to pain, Babiker said. If one of his patients insists on a narcotic prescription, he sends them to a pain specialist, and they may prescribe a narcotic, if appropriate.

“In a small area, there is a problem because we don’t have the resources or specialist such as a larger city would,” Babiker said.

He said if the current way of prescribing opioids for chronic pain continues, overdoses will continue.

“If you continue the same practice such as an opioid contract, it is the formality but it does not solve the problem,” Babiker said.

From 2000 to 2015 more than half a million-people died from opioid overdoses, and Americans die every day from an opioid overdose, according to American College of Physicians guideline for treating nonradicular low back pain published in February.

Babiker is hopeful that some are starting to think about different ways of dealing with pain.

“The legislation and politics play a part here,” he said. “In Ohio, a physician cannot prescribe narcotics or opioids for more than one week.”

A law signed by Ohio Governor John Kasich that mandates Ohio doctors, dentists and other medical professionals to prescribe for acute pain up to seven days of painkillers in adults and five days for children and teens in hopes that it will limit fewer opioids doses.

Babiker also mentioned the American College of Physician’s (ACP) study on acupuncture being as effective as an opioid. According to the Centers for Disease Control, the American College of Physicians (ACP) recommends in an evidence based clinical practice guideline published today in Annals of Internal Medicine that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

The recommendations have not changed the trend of prescribing narcotics, which has grown over the past 10 years. Other solutions have to be found, Babiker said.

He said the recently established Families Against Narcotics Chapter in Huron County is a great step.

“You get the community on board, education on the school level and families, the physician and those who prescribe and then reach some agreement that limits the prescription of opioids’.” Babiker said.

“Even if I say ‘No I’m not going to prescribe this,’ the patient will go elsewhere to obtain the prescription which doesn’t solve the problem. It will solve the problem in my clinic, but it wouldn’t solve the problem out there.”

He said taking prescription opioids is a “risk with no benefits” and if people knew the truth behind the stigma they would look elsewhere to treat their acute or chronic pain.

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