Opioids—or opiates—are a class of painkiller drugs with a long history of medicinal use going back centuries. Despite their continuing importance as prescription medication, the last ten years have seen sharp increases in addiction and deaths caused by their overuse and abuse. Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices (CAPP), CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group and Forbes contributor discusses the origins, problems, and solutions to this growing public health hazard, noting that it is unfortunately physicians and the pharmaceutical industry that have been instrumental—however unintentionally—in creating this situation.
The problem with opioids is not their role in pain relief, but their production of euphoria. Extended use creates a tolerance which requires ever-increasing amounts to reach the same levels, or withdrawal symptoms can kick in. In the past, concerns about abuse led physicians to prescribe opioids sparingly for cases of cancer or surgery, but consumer concern in the 90s that doctors were undertreating for pain resulted in rampant prescription writing for almost any pain. Drug companies and advocacy groups encouraged doctors to take Continuing Medical Educational (CME) programs which used materials spreading the belief (despite contrary scientific evidence) that patients with pain faced little to no risk of addiction or overdose. These CME programs often ignored a common trend of opioid users transitioning to heroin, with the result of four in five heroin users starting off with prescription opioids and quadrupled heroin deaths from 2000 to 2013.
While drug companies continue to promote opioids even for minor pains, in the face of this health crisis, progress has been made to combat the problem. The Drug Enforcement Administration (DEA) classified Vicodin—the most commonly prescribed opioid—as a more controlled substance, while drug makers added black box warnings, and the FDA ordered closer surveillance of the drug post-market.
Despite continued resistance from the pharmaceutical industry towards further regulation, physicians can still make a difference. Keeping up to date with accurate information on the risks of these drugs allows for the safer practice of medicine, and decision support tools already in use by the Permanente Medical Group can further increase patient safety. The tools include guidelines for creating written treatment plans and designating one prescriber for each particular patient, along with the crucial step of integrating and connecting physicians so that they know what is happening with patients outside of their own interactions. This includes how often they are seen for monitoring follow-up, their available access to mental health experts and addiction specialists, etc.
Fixing the opioid crisis will take time and effort from both legislators and practitioners, but some good results are already coming in; opioid prescribing has dropped thirty-seven percent (scripts for Oxycontin, one of the most addictive opioids, dropped seventy-five percent, and patients taking the highest doses had effective pain relief with the biggest reductions in usage). Moving forward to solutions through legislation and regulation will be critical, and can be helped by several steps. Enforcing measures against those physicians recklessly prescribing opioids, educational initiatives to help everyone understand the dangers of opioids, and keeping better track of patients’ history with drug and alcohol use along with expanding alternative pain relief measures are all key next steps for halting the epidemic.
Every life lost to opioid addiction is a tragedy, but we have the power to do something about it. While the crisis is indeed widespread, there are solutions in play with real and measurable results.
Read Dr. Pearl’s Forbes blog here: How American Medicine Created—And Can Now Solve—The Opioid Crisis
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