Every day, more than 115 Americans die after overdosing on opioids. This is a shocking number, especially considering that many of these opioids were prescribed by a doctor. The misuse of and addiction to opiate painkillers is a major crisis in our country that has reached epidemic proportions. Not only does it affect the health and wellness of our citizens, it impacts the social and economic welfare of our communities. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse in the United States is about $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and involvement by the criminal justice system.
How did we get here? What can be done to improve matters? In the late 1990s, pharmaceutical manufacturers began to market drugs such as Oxycodone and Hyrdocodone as safe, effective painkillers with low risk of addiction or abuse. Doctors were encouraged to prescribe them at greater rates to their patents with chronic pain. As the number of patients taking these medications increased, it became clear that the medical profession had been misled about the addictive and dangerous nature of these medications and the ranks of patients with addiction problems grew markedly.
This issue has become a public health crisis with devastating consequences. Not only have we seen sharp increases in opioid misuse and related overdoses, but also a rising incidence of neonatal abstinence syndrome due to opioid use during pregnancy. Because patients sometimes find themselves cut off by their doctors when they develop an abuse problem, heroin use has increased as well. The rise in injection drug use has contributed to the spread of infectious diseases such as HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution.
In response to the opioid crisis, the U.S. Department of Health and Human Services is focusing its efforts on five major priorities: Improving access to treatment and recovery services, promoting use of overdose-reversing drugs, strengthening our understanding of the epidemic through better public health surveillance, providing support for cutting-edge research on pain and addiction, and advancing better practices for pain management.
As medical professionals, what can be done to help curb the rising tide of addiction? Despite their best intentions, doctors admit they are often hamstrung in their efforts to battle the spread of opioid abuse by the same factors that hinder other efforts to improve patient health: a lack of time and money. The entire healthcare system, they say, seems geared toward getting patients in and out as quickly as possible, exactly the opposite of what a patient struggling with addiction requires. “A doc can say, ‘I’ll spend time talking to my patient explaining the danger of these drugs and trying to get them to go to physical therapy instead, or I can write a prescription and have them out in five minutes,’” says Dr. Robert Raspa, a primary care physician in Jacksonville, Florida, “It sounds callous, but in a busy practice where you want to get back to treating patients with diabetes and heart failure, it’s a quick way to get them out of your office. Doctors are being pressured from many sides.”
Many primary care physicians and other such providers, including nurse practitioners, physician assistants, and EMTs lack adequate training in substance use disorders or have archaic ideas about addiction. Medical professionals need to take on board the idea that just because someone has struggled with addiction doesn’t mean they don’t need medication post-surgery or should be chided about their past when asking for pain relief. Also, not all addicts need or will benefit from a 12 step program or residential rehab, though that is a popular solution, it is not the only one. Doctors also need to familiarize themselves with natural remedies and supplements a former addict may be using to cope with their issues. With access to the internet, some patients have found alternative remedies that work for them and these things should not necessarily be written off if they are making a positive difference in the patient’s life.
Ultimately, the medical industry has a long way to go to stop the opioid epidemic, and listening to the patient, rather than banning the medications or shaming the addict, is going to be the first step. At ECMA we are dedicated to keeping up with research on this and other pressing issues in our field and to supporting our members as they come up with solutions and fixes for their patients.