"With the first cut of the scalpel, excruciating pain exploded in my foot, and I was shocked speechless. I froze, paralyzed, terrified that any movement would jostle that knife digging into my flesh." Angelika Byczkowski, a patient suffering from Ehlers-Danlos Syndrome (EDS) has felt multiple surgeries through anesthetics.
The Department of Health and Human Services and the Drug Enforcement Administration have recently been working together to increase access to medication-assisted addiction treatment (MAT). The HHS and DEA are aware that doctors able to prescribe these medications are in short supply, which is one of the reasons they are looking to ease restrictions on MAT.
Emerald Coast Medical Association is dedicated to keeping our members up to date on any legal changes going on in the medical community. The most recent one being a massive package of measures in response to the ongoing opioid crisis. This package includes over 70 bills, each of which makes a significant impact on how the opioid crisis is handled.
What do we do about the opiate crisis? Everywhere you look, you see a lot of hand-wringing and concern regarding this question. And with good reason! Opiate overdose and death rates continue to soar, and while the rate of prescribing has come down, the rate of consumption has not appeared to change.
As doctors, we are on the front lines of this epidemic and often feel helpless to make a change. Meanwhile, legislators are patting themselves on the back for implementing guidelines like prescription limits that tie our hands, do little to help those in chronic pain and may even harm patients already caught in addiction’s grip.
For example, in 2014, Hydrocodone was rescheduled in an effort to curb the prescriptions being written for this addictive pain medication. The DEA’s policy was revised to limit prescriptions to a 90 day supply and only allowed physically written prescriptions, handed to the patient, rather than allowing them to be phoned or faxed into the pharmacy.
Researchers at the University of Michigan were able to study almost 22,000 patients in Michigan who had undergone one of 19 elective surgeries, such as a hip replacement, both before and after the policy was updated. Surprisingly, their data showed that there was an immediate rise in the number of opioid prescriptions filled after the schedule change.
Analysis of the data suggests that doctors may be motivated to prescribe the maximum possible amount, given the restrictions, so that the patient will not have to visit a walk-in clinic or emergency room or make another trip back to the office. What’s more, the characterization of the opioid crisis as being caused by doctor-prescribed medications has been repeatedly shown to be false.
According to a 2016 national survey conducted by the Substance Abuse and Mental Health Services Administration, 87.1 million U.S. adults used some form of prescription opioid, prescribed or obtained illicitly, at some point in the previous year. But only 2% developed any kind of “pain reliever use disorder,” a blanket term that ranges from occasional overuse to outright, daily addiction.
Another study, published in Pain Medicine magazine, excluded all chronic pain patients with a history of drug abuse and found that the remaining patients who were prescribed opiate painkillers developed addiction at a rate as low as .19%. Patients who do become addicted to their prescribed medication often have other problems, depression, anxiety, existing or past substance abuse issues or alcoholism. It has also been shown that far more people misuse prescription medication that they obtain from a friend or relative or purchase from a drug dealer than medication they themselves were prescribed.
Limiting the number of pills prescribed or manufactured in the country only serves to hurt patients who need them, and limit what their doctors can do to help. As we see from the news stories, addicts will find a way to feed their addiction, legal or not. Prescription limits do more to punish those who want to follow their doctor’s advice and treat their pain legally, than those who would abuse opiate pain medication.
Emerald Coast Medical Association is committed to supporting doctors in efforts to make our voices heard in Tallahassee and Washington D.C. As a group, we can work together to influence decisions in government that impact us and our patients. If you are not yet a member, we encourage you to come to a monthly meeting and learn about the advocacy and encouragement we can provide.
How can we solve the opiate crisis? If you’re like most practitioners, you have thought about this problem and found very few helpful solutions. As the death toll rises, steps are being taken to prevent future patients from winding up addicted to opiates but how can we help those who are already taking them?
As we all know, opioid use has skyrocketed in the United States, increasing by 300 percent from 1997 to 2010. The Centers for Disease Control and Prevention released an in depth-analysis in March showing that drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of those deaths involved a prescription or illicit opioid.
Opioids. The very word can strike fear into a medical practitioner’s heart nowadays. While they are certainly an effective tool for managing pain in the short term, the dangers of extended use are causing serious problems in our country, not only in the medical industry, but the fields of criminal justice, mental health, economics, even the arena of marriage and family is being negatively impacted by the epidemic of opioid abuse and addiction.