America’s love affair with prescription opioid painkillers is now plain. In the last few years, we have scrambled to put into place strategies to combat the worst drug epidemic in U.S. history. If we are going to fight the opioid epidemic effectively, there are 3 hard-earned lessons we need to pay attention to.
Efforts to Fight the Opioid Epidemic Are Working… Sort Of
The government has made many efforts to fight the opioid epidemic. Some have included:
- Monitoring programs that make it harder for the drugs to be overprescribed and diverted
- Legislation allowing easier access to the overdose antidote naloxone
- The creation of abuse-resistant formulations of OxyContin and other painkillers
- Informational campaigns about the addictive potential of prescription opioids
The battle is far from won, but there are glimpses of progress. Prescription overdose deaths, which had quadrupled since the late 1990s, have dipped at last.
The successes, however, have sometimes come with unintended consequences. Among the hard lessons, three things stick out:
1. We Need More Commitment to Treatment
We now have tracking programs that make it harder for patients to shop for multiple prescriptions and for unscrupulous doctors to overprescribe. This has begun to stem the flow of opioids. But there were many who were already addicted to opioid painkillers, such as OxyContin, Vicodin and Percocet. Many of these turned to heroin, also an opioid, as a substitute when they could no longer get their hands on prescription opioids. As a result, while prescription painkiller deaths declined in the past few years, heroin overdose deaths doubled, according to CDC statistics.
Care for those already addicted
We are doing good work to prevent new addictions to prescription painkillers. However, we must also care for the millions already struggling with opioid addiction, so heroin won’t appear to be their only option. That means strategies to increase access to opioid treatment programs. We especially need more treatment centers that include medication-assisted therapy, such as buprenorphine and methadone.
Majority of addictions began in legitimate pursuit of pain relief
From 1997 to 2011, the number of those seeking treatment for painkiller addiction increased 900%, note researchers in a study in the Annual Review of Public Health. The majority first started using prescription opioids in pursuit of legitimate pain relief. The researchers lay the blame for the prescription opioid epidemic on doctors and aggressive pharmaceutical marketers.
Insufficient treatment facilities
Not surprisingly, the treatment capabilities haven’t kept up with the need. A report in the American Journal of Public Health found that 96 percent of the states had opioid addiction rates higher than buprenorphine treatment capacity rates. “Without better access to addiction treatment,” lead author Andrew Kolodny, MD, said in a news release announcing the study’s publication, “overdose deaths will remain high and heroin will keep flooding in.”
2. We Need More Education
A person’s first use of opioids most commonly comes after filling a doctor’s prescription. A 2014 survey of 1,000 primary care physicians found that many doctors misunderstand basic facts about the drugs they’re prescribing. Among the findings:
- Many painkiller pills now have abuse deterrents. Some, for example, can’t be crushed effectively, making them difficult to snort or inject for a quicker and more intense high. Nearly half of the surveyed doctors believed abuse deterrents meant the pills were less addictive than regular opioid pills. They aren’t. The safeguard simply makes them less appealing to those who are seeking a high rather than pain relief.
- A third of the doctors believed that opioids were most commonly abused through snorting and injection. Therefore they thought prescribing abuse-deterrent pills represented less risk. In reality, the majority of addicts ingest their pills.
These misunderstandings can lead to dangerous complacence. Both doctors and patients might believe they’re dealing with a safer form of the opioid. “Our findings highlight the importance of patient and provider education regarding what abuse-deterrent products can and cannot do,” said G. Caleb Alexander, MD, MS, lead author of the study and co-director of the Bloomberg School’s Center for Drug Safety and Effectiveness, in a news release. “When it comes to the opioid epidemic, we must be cautious about overreliance on technological fixes for what is first and foremost a problem of overprescribing.”
3. We Need More Research
In 2014, the National Institutes of Health tasked a panel of experts to take a thorough inventory of all the scientific evidence surrounding the use of opioids for chronic pain. This panel wrote a report summarizing their findings. They came to a very disturbing conclusion: Where long-term pain is concerned, “there’s no research-based evidence that these medicines are helpful,” David Steffens, MD, MHSc, and one of the authors of the report, told UConn Today.
Opiods are the easiest, not the most effective
Instead, the panel found very little research at all on the subject — and what existed was mostly of poor quality. Rather, they witnessed a “dysfunctional health care delivery system that promotes prescription of the easiest rather than the best approach to addressing pain.” In other words, they found a recipe for disaster:
- Doctors are overburdened.
- Patients are hurting.
- Pharmaceutical salespeople are persuasive.
- A pill provides a swift solution that satisfies all — at least for the moment.
Particularly striking was that the lack of research meant there were few guidelines about the most effective ways to use the opioids. Doctors were left to rely on their clinical experience.
We don’t really understand opioids
We have less than 5% of the world’s population but use 80% of its painkiller supply. Yet the report reminds us we know little about them. Could we have been prescribing medications that not only have a high addiction risk but are largely ineffective?
Despite its conclusions, the panel noted that it’s clear some people benefit from prescription opioid use. Research needs to identify who might be good candidates for such treatment and who might not. To fight the opioid epidemic, we have to learn to balance the potential for good and harm in opioid painkillers.
By Kendal Patterson
Follow Kendal on Twitter at @kendalpatterson