Behind the Numbers: Fewer Opioid Prescriptions Make an Impact But Prior Over-Prescribing Will Continue to Haunt Us for Some Time
In 2016, the number of opioid prescriptions fell to its lowest level in more than 10 years. Yet, the latest CDC numbers show opioid overdose deaths rose seven percent in 2017. This seems counterintuitive; fewer drugs being prescribed should mean fewer deaths – but it doesn’t.
The over-prescribing of opioids by healthcare professionals led to the current public health crisis. When someone is prescribed opioids and becomes addicted, they frequently experience these phases: Refilling the prescription unnecessarily, stealing pills, buying expensive street pills, and then finally, graduating to the cheapest alternatives, heroin and fentanyl. Fentanyl, the now-common potent synthetic, is driving this current wave of the epidemic and responsible for many fatalities.
Unfortunately, tens of thousands of people are now addicted to heroin and/or fentanyl. So, while we identified the problem back in the late 2010s and tried to address it by clamping down on prescriptions, it wasn’t enough to stop the current surge of addiction.
In the early 2000s, the description of pain as the “fifth vital sign” helped further the idea that physicians needed to respond to it more aggressively. To help patients get relief as fast as possible, they ramped up opioid prescriptions. At the same time, there was a lack of education around substance use disorder and its risk factors, so patients predisposed to it with painful injuries were given highly addictive medication.
When we examine this scenario, it’s clear there are many ways in which we collectively caused this epidemic. And while we can’t save those parents, siblings, and friends who have lost their lives, we can continue to take steps to create meaningful and sustainable change.
1. Educate. We must universally abandon the idea there is a moral aspect to addiction. Addiction is not a lack of willpower, but instead a chronic disease. The treatment community plays a critical role here by educating patients, families, and healthcare professionals on the true nature of addiction as a brain disease.
2. Screen and prevent. Just as with any chronic disease, screening is necessary, and prevention is key. Giving parents, schools, counselors, and pediatricians access to quality treatment and educating the community about the dangers of experimentation should be top priority.
3. Understand pain. We now know opioids are not always effective for chronic pain, and while there are certain times when they are necessary (for example, cancer pain), we need to re-examine the reflex we’ve developed that pain equals pills. Emotional pain also can manifest as chronic pain. Doctors need to be mindful of patients with a proclivity for self-medicating and be proactive about recommending alternative approaches to pain management.
4. Embrace the chronic disease treatment model. Perhaps the most important step forward at this stage, though, is making quality treatment available. What makes Caron’s opioid program unique is our understanding that we’re with patients for life. This is where insurance companies need to follow our lead and change the paradigm of addiction treatment. By treating addiction as a chronic disease instead of taking an acute approach – we are proactively investing in saving lives and reducing the overall cost and impact to society.
It might not always seem like it, but we are gaining ground in this battle for millions of lives. Yes, we are still experiencing a high fatality rate, a lingering effect of our over-prescribing days that will likely haunt us for some time. However, there is hope. Research and education are making an impact and we’re learning from history so that we don’t repeat it.
Chronic Pain Management: There are Alternatives to Opioids
By Dr. Dean Drosnes