“Many clinicians have told me they weren’t aware of just how bad the problem had gotten. Many were not aware of the connection between the epidemic and prescribing habits.”
~United States Surgeon General Dr. Vivek Murthy
Citing an “urgent health crisis”, the US Surgeon General has written a letter to every doctor, dentist, and nurse practitioner in America, in hopes of addressing – and turning the tide on – the nation’s opioid epidemic. This is the first time that anyone in that position has attempted to reach out in such a universal, collaborative manner.
How Bad Is the Problem of Pain Med Abuse, REALLY?
In the letter, Dr. Murthy bluntly calls the opioid epidemic a crisis that threatens America. When one looks at the available statistics, it is evident that he just might be right. According to the American Society of Addiction Medicine’s “Opioid Addiction: 2016 Facts & Figures“:
- Drug overdoses are the leading cause of accidental deaths in America, with more than 47,000 overdose fatalities in 2014
- Just under 19,000 of those deaths involved prescription painkillers
- Every day in the United States, 46 people die of prescription opioid overdoses
- More than 10,000 additional deaths were heroin-related
- Between 1999 and 2014, more than 165,000 Americans died because of prescription opioid pain medications
- Nearly 2 million Americans age 12 or older have a substance abuse problem involving prescription opioid painkillers
- Almost 600,000 more Americans abuse heroin
- Among people who abuse heroin, it is estimated that 23% will become addicted
Part of the problem is due to improper or ill-advised prescribing practices by physicians:
- In 2015, there were over FOUR BILLION prescriptions written in the United States – a disproportionate number of them were opioid painkillers
- In 2012, there were 259 MILLION opioid pain medication prescriptions written – enough for every American adult to have their own personal bottle of pain pills
- Opioid prescriptions per capita increased 7.3% 2007-2012
- Physicians in the highest-prescribing state wrote nearly 3 TIMES as many opioid prescriptions per person as the lowest-prescribing state.
- For example, physicians in Tennessee wrote 22 times as many opioid prescriptions as were written in the state of Minnesota.
- The highest state had physicians writing almost one-and-a-half prescriptions per person.
How Did the Pain Medication Problem Get This Bad in the United States?
Dr. Murthy lays much of the blame squarely at the feet of the medical and pharmaceutical professions, rooted in practices developed two decades ago. According to Dr. Murthy:
- Physicians were trained to “aggressively” treat pain
- There is no national consensus or standard about when prescription painkillers should be prescribed or how much should be prescribed
- Heavy marketing of opioid pain medications to physicians
- Incorrect training/assumptions by many medical professionals that opioids were not addictive– almost a decade ago, Purdue Pharma pleaded guilty to the fraudulent marketing of OxyContin as “less addictive” than other pain medications, resulting in a $64 million fine.
- “Pill mills” – high-volume, for-profit pain clinics that habitually prescribed opioids
- Even now that the risks of opioids are known, well-intentioned doctors STILL have a dichotomous duty – balancing the desire to ease their patients’ pain with the dangers associated with opioid misuse, dependence, addiction, and overdose.
What Is Being Done to Reverse the Opioid Epidemic?
In March, 2016, the Centers for Disease Control and Prevention – the top federal health agency in the country – issued their first-ever guidelines for the prescribing of opioid pain-killing medications. To that point, it was the most comprehensive effort ever to address the issue.
In an essay published in the New England Journal of Medicine, the CDC’s Director, Dr. Tom Frieden, and the Director of the CDC’s National Center for Injury Prevention and Control, Dr. Deborah Houry, wrote, “Management of chronic pain is an art and a science. The science of opioids for chronic pain is clear – for the vast majority of patients, the known, serious, and too-often fatal risks far outweigh the unproven and transient benefits.”
Some of the guidelines included:
- Opioid painkillers should NOT be “considered first-line or routine therapy for chronic pain”
- Opioid painkillers should primarily be prescribed for short-term acute pain, or for palliative cancer relief
- The preferred options should be, in order – non-medication therapy and non-opioid medication
- Opioids should only be administered when the benefits to “pain and function” outweigh the hazards
- When there is no other option, opioid medication should only be given in the smallest dose possible, for the shortest duration possible, AND used in conjunction with exercise therapies and non-opioid medications
- The “shortest duration possible” for the initial prescription should be no more than two or three days, during which time other pain-management options should be explored
- When opioids need to be prescribed longer, an additional benefit/risk re-evaluation should be conducted within three months
As Dr. Frieden said, “We know of no other medications routinely used for a nonfatal condition that kills patients so frequently. We hope to see fewer deaths from opiates. That’s the bottom line. These are really dangerous medications that carry the risk of addiction and death.”
Modifying physicians’ prescription practices also seems to be the philosophy behind Dr. Murthy’s letter. He calls for his fellow physicians to “educate ourselves to treat pain safely and effectively“, and encloses a pocket copy of the CAC’s Opioid Prescribing Guideline. His other recommendations:
- Screen patients for risk of opioid abuse
- Remove the stigma of addiction by talking about and treating it as a chronic disease, rather than a moral weakness
This effort by Dr. Murthy was inspired by his travels around the country as the Surgeon General. He discovered that many doctors – even personal friends of his – simply did not have a clear enough understanding of how dangerous opioid medications can be.
What Role Do Patients Play in Controlling How Opiates Are Prescribed?
Physicians aren’t the only ones who can have an impact on the reduction of the number of opioids that are prescribed. Patients should educate themselves about the real risks carried by opioid painkillers – even when used exactly as prescribed.
A person who has lingering, chronic pain should be prepared to have an open, honest conversation with their provider about different alternatives to opioids. Then, the patient has the further obligation to make a sincere effort to adhere to any non-opioid pain relief recommendations from their doctor.
The tie of the opioid epidemic IS reversible, with education, modified prescribing practices, and a greater spirit of cooperation and teamwork between physicians and their patients.
To his fellow physicians, Dr. Murthy concluded with, “Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way.”