Defeating the opioid epidemic’s march across America

Defeating the opioid epidemic’s march across America

America is battling a bigger, brutal fight than she has ever faced – the opioid epidemic.  Just how bad is it?  In a world with more than 7 billion people, over 80 percent of the world’s opioids are consumed in the U. S., which makes up only 5 percent of the human race.

It is being called the worst drug crisis ever in American history.  Headlines such as, “Louisville, Kentucky receives 52 overdose calls in 32 hours,” are surreal and unimaginable as this caption cries out.  Sadly this has become an all-too common newspaper write-up across the nation. 

According to the Centers for Disease Control and Statistics (CDC), every day, 91 Americans die from an opioid overdose which includes prescription opioids and heroin.  From 2000 to 2015 more than half a million people died from drug overdoses with prescription opioids being a driving factor in the fifteen-year increase.  During those years is when the amount of prescription opioids dispensed in the U.S. nearly quadrupled. In fact, more Americans died from a drug overdose in 2016 than from traffic accidents, and three out of five of those deaths involved a highly addictive opioid. 

Add to this problem – heroin.  When prescription drug abusers are searching for a stronger, cheaper fix, they turn to heroin, an opiate that’s often the next step for users.

What are opioids?

Opioids are pain relief medications that when taken in low doses can be safe and effective.  They are the strongest pain relieving medications available with morphine considered as the benchmark opioid.  All other licit prescription opioids – oxycodone, hydrocodone, codeine – fall either above or below morphine in terms of pain-reliving potential.  Fentanyl is another licit prescription opioid – it is a synthetic opioid pain reliever many times more powerful than other opioids and is approved for treating severe pain, typically advanced cancer pain.  Illegally made and distributed fentanyl has been on the rise in several states.

The illicit drug heroin, also falls under the same class of drugs called opioids. Its use has increased across the U.S. among men and women, most age groups, and all income levels.  

Opioids are just like any other medication in that they can come with risks and side effects including the risk of death, particularly if abused or not taken exactly as prescribed by a doctor.

In the past, opioids were generally prescribed for cancer patients undergoing painful treatments of radiation, chemotherapy or other symptoms of pain that were too difficult to manage otherwise.  Nowadays, opioids are routinely given to individuals who do not have cancer and can range anywhere from chronic back pain to muscle pain relief.

What happened – what precipitated the opioid epidemic?

How did our country get to this point in its history of this devastating and massive public health problem?  Part of the blame can be traced back to the mid-1990s when Dr. James Campbell introduced to the American Pain Society the idea of evaluating pain as a patient’s “fifth vital sign.”  Besides checking your pulse, blood pressure, respiratory rate and temperature, we are now asked “are you experiencing any pain” at all doctor’s visits.  We’ve all seen the angry and happy faces on a scale of 0-to- 10.  Doctors were encouraged to treat pain based on a patient’s answer.  Suddenly, if a patient complained of pain, they were often written a prescription to bring it down to a 0.

However, our country has had an affinity for opiates dating back to the 1800s, predating the Civil War.  Many soldiers got hooked on morphine used to treat their injuries.  Opiates which come from the opium poppy have been around for thousands of years.  Morphine, the most active ingredient in opium, is named after Morpheus, the Greek god of dreams.

The term “opioid” which means “opiate-like” began in the 1950s.  It was the Food and Drug Administration that approved painkillers that the word opioid is most associated with today that began with Vicodin in 1984, OxyContin in 1995, and Percocet in 1999.

How do opioids become a problem?

Opioids can become a potential problem for anyone because of how they work in the body.  The drug interacts with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. Addiction is the primary concern with their use and reason why people can become dependent on these drugs.  If you are someone who has endured years of chronic pain and suddenly are prescribed an opioid for the relentless pain rewarding with tremendous relief, it’s quite easy to become hooked on this medication

The factors of dependence and tolerance are a main force driving this epidemic.   Dependence can occur when opioids are taken daily and the body begins to rely on these medications.    If a person suddenly stops taking the medication the body can go into withdrawal.  A person cannot control dependence on an opioid as it is simply the body’s natural response to this drug. 

Tolerance is another issue.  Many people experiencing chronic pain find they have to continually increase the dose to get the same pain relief.  The longer a person is taking an opioid, the less sensitive opioid receptors in the body become.

What will it take to fix this problem?

In order to halt the opioid epidemics strangle on our nation, we must and can do better on taking action to defeat this beast.  When we work together with the same goal in mind - vastly reducing distribution of pain medications like candy - all of us as physicians, other healthcare workers, lawmakers, and as a nation, can help save countless lives while ending this epidemic.

Here are some ideas of what must be done to fight and defeat the opioid epidemic:

·      Educate physicians.  Starting with future doctors in medical school to seasoned physicians, train them on pain management and addiction treatment.  All physicians should pursue the education and training necessary to prescribe controlled substances safely and appropriately.  Be more open to the effectiveness of non-opioid medications for treating chronic pain. Another avenue for physicians is to use a technique called motivational interviewing which engages the patient and encourages them to change their behavior by helping them discover what motivates them.

·      Educate patients.  Not all patients in pain need to be immediately placed on an opioid medication.  If the person has low back pain and needs to lose weight, work first on weight loss management to help alleviate the pain before automatically writing a prescription.

·      Better prescription monitoring programs needed.  There needs to be improved methods for physicians and public agencies to catch patients who are doctor-shopping for opioids

·      Take substance abuse as seriously as other conditions.  If a person has hypertension, we treat them for that condition instead of waiting to see if they have a heart attack or not.  The same treatment should be applied to patients who are abusing these pain medications.  Before writing a prescription for a pain pill screen the patient for risk factors for substance abuse.

·      FDA has a responsibility.  The Food and Drug Administration needs to develop

formulations of opioids that are not as addictive.  More policing of what medications get approved and what doesn’t and working with the Drug Enforcement Agency (DEA) can help curb this problem.

 ·      Better labeling.   Pharmaceutical companies can do a better job of improved labeling of these medications.

As a physician, to me fighting the opioid epidemic crisis is both a professional and ethical obligation all physicians need to embrace.  Even though the solution to this problem will not happen overnight but we have to begin somewhere.  When we do our part as medical professionals we can and will come out stronger, better prepared and more knowledgeable to never let such a widespread sweeping epidemic ever happen again.