Side effects

The toll of controlled substances on community health services

Nikki Ehn

With to a slight increase in the use of substances like marijuana, methamphetamine and heroin, local physicians are seeing more drug-related cases at hospitals and clinics.

Nikki Ehn, MD, was been a family physician with Webster City Medical Clinic, and now at Van Diest Medical Center and Family Health Clinic. She practices full-spectrum family medicine including clinic, inpatient, OB and nursery care.

“As a family physician I work with people throughout their life, in preventative health and ill visits, in clinic and in the hospital. I provide prenatal care and deliver babies, caring for both the mother and the baby,” said Ehn. “I also serve on the Hamilton County Board of Health.”

Ehn said she occasionally comes into contact with patients who use drugs and has seen first-hand the negative toll this has on not only the body, but the patient’s well-being as a whole.

“The substances can cause adverse health effects, both in short and long term use,” Ehn said. “They can also lead to social issues, causing stress in relationships, legal problems, problems with employment. When people become addicted to a substance, they will often seek to obtain that substance or use that substance at the expense of the rest of their health.”

Patients who are addicted to substances like opioids will sometimes seek medical care from multiple sources in order get the drugs they crave.

“For patients that are addicted to pain medications, like opioids, they will often see multiple providers, at multiple locations, in an attempt to get more of the medication,” said Ehn. “This can result in excessive clinic and ER visits, and when discovered, often leads to patients getting ‘fired’ from their outpatient clinics. This leads them to seek more care at the ER, which is costly.”

This leads to unnecessary testing by multiple providers. It also puts strain on medical providers working to put their patients’ health first.

Those known to be an opioid-seeking patient (one that has been seen by multiple providers or has a history of seeking opioid medications from multiple sources), this can also color the way they are perceived by providers,” Ehn said.

“It could also lead to unnecessary testing. For example, if a person presented to the ER complaining of abdominal pain, they would likely have some testing done, including blood work and imaging (x-ray or CT). If someone that was hoping to get a prescription for opioids came in with this complaint, they would still get the appropriate work-up.”

Most of the local facilities are separate entities and don’t have medical records linked together.

“Our medical records don’t communicate with each other, so we have no way of knowing that a patient has already had an x-ray and lab tests for a certain complaint, unless we can contact the office and get those records (with patient permission),” Ehn said. “We try to communicate with each other, but it’s not always possible to do that at all hours of the day.

Ehn said that can mean there’s a duplicate cost to the patient and insurance for testing and the risk both facilities would give prescriptions for opioids.

According to Ehn, Van Diest Medical Center has contracts that are to be signed by patients who receive chronic controlled substances. These contracts lay out the requirements for receiving the controlled substance from their clinic. This includes that they will only see one provider, will only fill their prescriptions at one pharmacy, they will agree to random urine drug testing, will not call for early refills and will not use other substances.

“If the contract is violated, they will no longer receive controlled substances form our clinic,” said Ehn. “We also use the Physician Monitoring Program website which is a site that all pharmacies in Iowa use. When a person fills a controlled substance, the pharmacy reports this to this database. We can then access the database and see where and when patients filled prescriptions, as well as who wrote the prescription, when the prescription was written, the medication that was filled and the quantity that was dispensed.”

Van Diest also has a pain management specialist, Dr. Christian Ledet, who has a clinic twice per month in their specialty clinic space. He helps manage chronic pain patients, both with procedures like epidural injections, and with prescribing medication.

“We refer patients with addiction and rehab needs to Community and Family Resources locally, and then to any other rehab facility that might have openings, as needed,” said Ehn.

Ehn noted the importance of using prescription medications as prescribed.

“Medications are prescribed in specific ways to help ensure safety and efficacy. If you choose to use your medicine in a manner different from the prescription, you risk potentially taking too much of the medicine, which could be dangerous or too little of the medicine, which would not be efficacious. “We are seeing more and more opioid overdoses that are unintentional,” Ehn said. “If you give your medication to someone else, they could have a medical condition or be taking another medication that could interact in a dangerous way with your medication.”

Illegal substances are not regulated in any way, making them detrimental to users. Often, street drugs may have many different compounds in them that could be dangerous.

“The use of these drugs can lead to addiction and dependence, which can cause people to give up on other areas of their life to seek this substance,” Ehn said. “People lose jobs, family members, homes, health in the pursuit of these substances.”

“Our team at Van Diest is committed to the health of Hamilton County. I strongly encourage people to be proactive about their health. Preventing illness is so important and will help people to live a healthier life, and avoid the need for a lot of chronic medication,” said Ehn.

Ehn said the hospital offers services such as health coach. Angela Ehlert, RN helps people meet their goals and manage chronic conditions.

“If you are struggling with chronic pain, we can work to find a way to help that may not involve chronic pain medication. And if you are struggling with addiction or dependence issues, we can help you find the right resources to get through this,” Ehn said.