It was just a few years ago that the nation at last awakened to the deadly consequences of its love affair with prescription opioid painkillers and scrambled to put into place strategies to combat what the Centers for Disease Control and Prevention (CDC) has labeled the worst drug epidemic in U.S. history.
Those efforts have included monitoring programs that make it harder for the drugs to be overprescribedand diverted, legislation allowing easier access to the overdose antidote naloxone, the creation of abuse-resistant formulations of OxyContin and other painkillers, and informational campaigns about the addictive potential of prescription opioids.
The battle is far from won, but there are glimpses of progress. Most crucially, prescription overdose deaths, which had quadrupled since the late 1990s, have dipped at last.
The response to the prescription opioid epidemic, however, has sometimes come with unintended consequences, and many of our advances have served to expose just how much we have to learn about truly reining in abuse of the drugs we’ve been prescribing and consuming in record numbers. Among the hard lessons, three things stick out:
Creating tracking programs that made it harder for patients to shop for multiple prescriptions and for unscrupulous doctors to overprescribe has been crucial in stemming the flow of opioids. But it also caused many who were already addicted to opioid painkillers such as OxyContin, Vicodin and Percocet to turn to heroin, also an opioid, as a substitute when their supply was interrupted. As a result, while prescription painkiller deaths declined in the past few years, heroin overdose deaths doubled, according to CDC statistics.
In response, many medical leaders and researchers are calling for recognition that as we work to prevent new addictions to prescription painkillers, 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, especially those that include medication-assisted therapy such as buprenorphine and methadone.
From 1997 to 2011, the number of those seeking treatment for painkiller addiction has increased 900%, note researchers in a study published in the March 2015 edition of the Annual Review of Public Health. Those seeking treatment are primarily people whose dependence began not as a result of recreational use but in legitimate pursuit of pain relief, note the researchers, who lay the blame for the prescription opioid epidemic on overprescribing doctors and aggressive pharmaceutical company marketers.
Not surprisingly, the treatment capabilities haven’t kept up with the need. A report published in the August 2015 edition of 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.”
A person’s first use of opioids most commonly comes after filling a doctor’s prescription, but a 2014 survey of 1,000 primary care doctors published online in June 2015 at the Clinical Journal of Painfound that many doctors misunderstand basic facts about the drugs they’re prescribing. Among the findings:
These misunderstandings can lead to dangerous complacence by doctors and patients, who 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 becautious about overreliance on technological fixes for what is first and foremost a problem of overprescribing.”
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 and write a report summarizing their findings. They came to a 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.
Instead, the panel found very little research at all on the subject — and what existed was mostly of poor quality. They also wrote in their report that they’d discovered a “dysfunctional health care delivery system that promotes prescription of the easiest rather than the best approach to addressing pain.” Inother words, doctors are overburdened, patients are hurting, pharmaceutical salespeople are persuasive, and a pill provides a swift solution that satisfies all — at least for the moment. Particularly striking to the panel 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.
The report is a disturbing reminder that despite our national enthusiasm for prescription painkillers — we have less than 5% of the world’s population but use 80% of its painkiller supply — 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. Determining who might be good candidates for such treatment and who might not, while balancing the potential for good and the potential for harm, the panel wrote, must be the key goal of desperately needed research.
By Kendal Patterson
Follow Kendal on Twitter at @kendalpatterson
Posted on April 15th, 2016 in Blog