Opioids are common pain medications that are used for the treatment for mild to moderate pain. These medications are highly addictive and bind to particular receptors in the brain and spinal column that produce a feeling of euphoria along with the relief of chronic pain. However, in the US they are becoming a leading cause of death due to overdoses. Opioids—such as oxydocodone, Percocet and others—are now gateway drugs to heroin and other narcotics. They are also becoming a drug of choice for those who have not abused drugs in the past. Now they are gaining increased in popularity due to ease of access– and their street value continues to grow. The sad fact is that in the last year, drug overdoses killed more people in the US than car crashes.
While some physicians are very diligent in the way in which they prescribe opioid type pain killers–others are not. Drug companies that make these compounds for profit have misled physicians with small studies touting opioid safety and many physicians have not done their due diligence in evaluating the addictive nature of pain medications. All of these factors have led to a practice of indiscriminate and irresponsible prescribing practices.
What are the Facts Regarding the Abuse of Opioids?
As a society, we are quick to accept a pharmacologic approach to treating any ailment. As a people we demand an immediate fix for any medical problem and often do not consider any other alternatives. Drugs are much cheaper way to treat chronic pain as opposed to a more comprehensive multi-disciplinary approach. Time with therapists, treatment plans involving meditation, yoga and exercise are not widely supported—it is simply easier to take a pill. Currently, the US accounts for over 75% of the world’s total opioid prescriptions. In the last year, over 260 million opioid prescriptions were written in the US alone according to the American Society of Addiction Medicine. Currently, drug overdose is the leading cause of accidental death in the US today. Of the nearly 50 thousand overdose related deaths in 2014, opioid overdoses accounted for over 18 thousand—only 10 thousand were due to heroin. In the last decade, opioid overdose rates have risen more than six fold. Women tend to be more at risk than men with overdose rates from prescription pain relievers up 400% over the last decade (as compared to 230% for men).
What Role to Doctors Play?
Obviously, physicians and other healthcare professionals are the source of opioid prescriptions. Don’t get me wrong—opioids do in fact have an important role to play in medicine in the short term treatment of acute pain related to accident, injury, surgery or the like. However, chronic opioid use must be avoided. These medications have numerous side effects and can be highly addictive in some patients. As a physician, it is incumbent upon me and my prescribing colleagues to choose the best treatment for a particular patient. It is never OK to enable abuse through writing recurrent, long term narcotic prescriptions. Unfortunately, financial pressures in medicine have created situations in which physicians feel as though they MUST write prescriptions of this type or fear losing patients to another provider who will. In addition, many patients with chronic pain require a great deal of time and effort during the course of a busy office day. Rather than spend the necessary time to create a more holistic and multi-disciplinary treatment plan, many physicians find it easier to simply write a prescription and move on the the next patient—thus enabling addiction.
What Is Our Government Doing to Address Opioid Addiction?
In March 2016, President Obama announced a new initiative (and new funding ) to combat opioid abuse and addiction. Currently, the FDA and DEA is considering regulations that will require “retraining” of doctors who prescribe opioid medications. Healthcare providers may be required to undergo re education in order to maintain a particular DEA prescribing certification. Many state medical boards already track opioid prescribing patterns and will often reach out to physicians who have unusual prescribing practices or prescribe higher numbers than their peers. Many of these physicians may be subject to disciplinary action.
Research dollars are being spent to investigate new types of pain relievers with less abuse potential and greater efficacy. Other studies are being conducted that will help better understand this type of addiction and how best to treat it. In addition, government dollars will be allocated to improve access to addiction treatment programs and the FDA will require new labeling of opioid prescriptions that will make their abuse potential much more clear.
Finally, drugs that reverse narcotics overdoses, such as naloxone (also called Narcan), are making their ways to city streets. It is imperative that we provide first responders as well as others in areas of high abuse rates with easy access to this life saving antidote during an overdoes. IF we do not, many more will die before we can change the course of the opioid epidemic in the US today.
While these proposed government sponsored initiatives do have some promise, it is unlikely that any of them will have an immediate impact. It is important that we continue to educate the public as well as healthcare providers to the risks associated with taking opioids. In addition, we must make it easier for physicians to develop a more comprehensive and multi-disciplinary approach to pain management. Those physicians who do not carefully prescribe narcotics and instead do so indiscriminately, must be sanctioned and must no longer be allowed to prescribe these medications. We must also address the behaviors of those who are addicted to these drugs—we must identify sources of these drugs in the community and eliminate them from circulation. We cannot wait for government to act FOR us and fix the problem through bureaucracy and legislation—as physicians and as citizens we must act on our own. While ultimately research into better ways to treat chronic pain and the management of addiction will produce new ways to treat our patients, we must all work together NOW in order to halt the alarmingly high rise in opioid use in our country today. Ask your physician for alternative ways to treat pain. If you are concerned you or your friends and loved ones are suffering from addiction—say something—get involved and help.