The United States is facing an epidemic of opioid prescription drug and heroin addiction. It is a public health crisis that continues to worsen despite considerable resources expended by federal, state and local entities. More importantly, the horrific loss of life continues to mount as public health practitioners, medical personnel, policy experts and politicians deliberate over strategies to combat the problem.
Today, prescription drug and heroin overdoses are the leading cause of preventable deaths for Americans, exceeding automobile accidents. In 2014, the CDC reported there were nearly 29,500 opiate-related overdose deaths in the U.S., with approximately two-thirds of those deaths attributable to prescription opioid drugs and one-third attributable to their synthetic cousin, heroin. When released, the CDC’s 2015 final statistics are expected to be similarly gruesome.
The opioid addiction epidemic is largely a self-inflicted national wound tied directly to the explosion of prescription opioid drugs in the last two decades. In 2013, according to the CDC, over 250 million prescriptions for opioid painkillers were written in the United States – enough for every American adult to have a prescription bottle.
With 5 percent of the world’s population, the U.S. consumes 80 percent of the world’s opioid prescriptions. Other nations use a wide variety of less risky methods to treat patient pain. Opioid over-prescription and associated addiction and mortality has become a uniquely American problem.
Health clinicians have clearly documented the direct, immutable nexus between the prescription and sales of opioid drugs and the explosion of addiction and overdose deaths. These drugs are everywhere — in communities, schools, workplaces and in home medicine cabinets, making them available for medical overuse or abuse.
Unfortunately, coverage of the issue has tended to suggest the epidemic is simply a matter of mostly young people “abusing” these otherwise safe-as-prescribed medications. That is a false meme offered by some unwilling to accept their role in the change in culture of opioid prescribing that has occurred in this country since 1999.
Without question, the exponential growth of prescribed opioid painkillers has contributed significantly to their availability for non-medical purposes and ultimately to a new surge in heroin use, but the age group with the greatest increase in prescription opioid mortality is 55-64-year-olds.
These fatalities are not young people abusing prescription opioids before a high school social event. They are likely patients unnecessarily provided opioid drugs for a multitude of pain conditions, for which they were never intended, who overdosed from their prescribed medicines.
So how did a nation with some of the world’s best physicians find itself in the midst of this public health crisis? A number of important factors have contributed to the routine use of opioid analgesics for acute and chronic pain conditions in the U.S.
First, medical education in our country has historically inadequately addressed pain management and addiction. Until recently, there were few medical school curricula that addressed the issue.
In the 1990s, this gap in medical education was filled by pharmaceutical company representatives who suggested to the medical community that the risk of addiction was less than 1percent — something the industry stopped asserting after the 2007 federal conviction of Purdue Pharma for misleading marketing practices.
Second, during the past two decades, growing numbers of patients with persistent non-cancer pain have routinely been offered opioid drugs for long-term use. In hospital and outpatient settings, the recognition of pain as the fifth vital sign, and the use of patient satisfaction surveys that focused on the extent to which a patient’s pain was relieved, created a standard of care that drove an increase in opioid prescriptions.
As a result, opioid drugs are regularly prescribed for all manner of pain, from fibromyalgia, to arthritis, indiscriminate back pain, migraines and wisdom tooth extraction.
Third, despite substantial numbers of people with persistent pain conditions in the U.S., access to multidisciplinary care and physician reimbursement for non-pharmacologic approaches is inadequate.
Finally, the Food and Drug Administration, charged with reviewing the safety and efficacy of drugs introduced into the marketplace, has adopted a “safe if used as prescribed” contention for new opioid applications and for new opioid use indications. Today, well over thirty opioids are on the U.S. market, and last August, the FDA approved the use of OxyContin in children as young as 11.
When it comes to opioid drugs, the FDA has not fulfilled its role in protecting public health, and given current opioid mortality statistics, they must now challenge their review assumptions regarding opioid safety.
Despite the persistence and seriousness of the opioid addiction epidemic, there are solutions at hand. Most strategies charting a path forward focus on three key components — preventing opioid addiction from occurring, keeping those afflicted by opioid addiction alive and providing effective, evidence-based treatment to those addicted.
Prevention includes educating the public about the nature of opioid drugs and their addictive qualities, as well as preparing citizens to be more informed patients for themselves, their children and for the elderly when receiving medical care.
But the most significant dimension to prevention is a return to more cautious prescribing of opioids. The CDC’s recently released voluntary opioid prescribing guidelines for chronic pain are an important first step, but more needs to be done in prescribing for acute pain conditions.
To protect those who are already addicted to opioids, a number of states have passed Safe Reporting-Good Samaritan laws to encourage reporting of overdose events. Each state needs such a law to ensure timely reporting of incidents. In addition, the overdose reversing drug, Narcan, is being widely distributed to law enforcement, emergency medical personnel and increasingly to loved ones to administer in an overdose event. Safe Reporting and use of Narcan save lives.
Finally, clinical data strongly support the use of evidence-based treatment involving a number of medications that demonstrate higher recovery rates from opioid addiction than traditional abstinence-only approaches. The use of MAT, coupled with individual therapeutic and peer support, is showing great promise and is supported by HHS, CDC, medical practitioners and a number of national advocacy organizations to treat opioid substance use disorder patients.
These and other related steps will be needed to stem the tide of the opioid addiction epidemic the nation is facing, and the effort will need the attention of federal, state and local community partners.
Don Flattery is an impacted parent, member of the Virginia Governor’s Task Force on Prescription Drug and Heroin Abuse and a board member of Physicians for Responsible Opioid Prescribing. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
