Opioids have dominated medical news in the past several years, and with good reason. With opioid deaths reaching a new peak of over 47,000 people in the U.S. in 2014, more and more medical professionals, lawmakers, and patients are realizing that this class of medications, once touted as a miracle drug in the treatment of chronic pain, may be more dangerous than helpful. Here’s a round-up of opioids in the news.
While many may think that heroin is the most dangerous type of opioid, the real danger may be lurking in your medicine cabinet. Prescription opioid abuse kills an estimated 28,000 people in the U.S. annually, more than automobile deaths.
President Obama is seeking to remedy that by more than doubling the current budget for battling opioid abuse. The majority of those funds would go directly to states to help them expand treatment programs and access to addiction services. Funds would be directly proportional to the severity of the problem in each state.
One of the most difficult aspects of stemming the tide of prescription opioid abuse is keeping track of patients and their prescriptions. Doctor shopping is the practice of moving from doctor to doctor in order to get multiple prescriptions for the same medications.
Medicaid and private insurance plans combat this practice by using patient review and restriction (PRR) programs. These programs coordinate care between doctor and pharmacy, ensuring that patients are able to get the pain relief they need with limited risk of abuse. Federal law prohibits PRR programs with regard to Medicare, but there is increasing support from both parties in Congress to change the law.
While not true for every area of the U.S., in some cities and town, opioids and opioid abuse have surpassed the level of alcohol abuse. In Erie County New York, admissions to treatment facilities for heroin and prescription opioids accounted for 39% of all admissions in 2014, as compared to 35% for alcohol. Admission to treatment centers for heroin was three times the admission for cocaine in 2014. Overall, the number of people admitted to treatment centers for opioid or heroin use in Erie County has doubled in the past seven years. These numbers are dramatic but indicative of an overall trend nationwide, with numbers of opioid overdose deaths quadrupling from 1999 to 2008.
With more people affected by opioid use, abuse, and dependence, the workforce – employers and employees – is beginning to feel the strain. From increased workers’ compensation claims that utilize opioids for pain management to increased absenteeism and expenditures on healthcare, opioids cost time and money.
In 2007, prescription opioid abuse cost over $25 billion dollars in lost wages from premature death, lost employment, increased healthcare costs, and costs incurred in the criminal justice system. The stigma of opioid use and dependence is also preventing some higher-status employees from seeking treatment, adding more to the societal cost of opioid abuse.
Recent articles in the news have begun to ask the medical profession to take a long, hard look at their role in the opioid epidemic. Citing the Hippocratic Oath, many authors and researchers are calling on the medical profession to be more mindful and informed about the potential dangers of prescribing opioids for anything but acute or cancer pain.
One way that the medical profession may have participated in the increase in opioid use is by redefining the term “addiction” as “dependence” to separate patients who use opioids illegally (addiction) from those who do not (dependence). The problem with opioid abuse has become so extensive that calls for more responsible diagnosis and prescription are coming from within the pain specialist community as well as without.
A new study has linked long-term opioid use to the development of depression. This study addressed the idea that risk factors for depression may be present in those with chronic pain but was able to ascertain that long-term opioid use did, in fact, cause an increase in depression for those who were not previously at risk.
As the population of the U.S. rises and baby boomers begin to feel the creaks of age and other medical conditions, there has been a corresponding rise in the number of opioid prescriptions that goes beyond the overall rise across demographics.
The good news is that baby boomers in particular seem to respond well to a treatment protocol that includes motivational interviewing (MI). This type of treatment uses non-confrontational dialogue to uncover the gap between what a patient says they want (to be free from opioid dependence) and what they actually do (continue to use prescription opioids).
A new study from the Boston University School of Medicine found that while only 25% of clinicians said they were very confident in their ability to manage patients who are prescribed opioids, ongoing education and training can help them to gain confidence. Clinicians in the study who completed ongoing education classes were better able to make informed decisions about prescribing, monitoring, and discontinuing opioid use for their patients.
At Pain Doctor, we follow these new developments in opioids and opioid therapies closely to better serve our patients. Responsible prescription and careful monitoring of opioid use is of paramount importance, as is patient education on the potential risks and benefits. We utilize a 12-step checklist when considering opioid prescriptions, and we encourage our patients to explore holistic treatments that include other forms of pain management.
The best way to determine which options will be most effective for your pain management is to talk with your doctor.