The Opioid epidemic is making headlines, and it is easy to think that the situation is a media-generated headline to keep the talking heads busy. Unfortunately, nothing could be further from the truth, The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids like fentanyl—is a serious national crisis. The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
Every day, more than 115 Americans die after overdosing on opioids. In 2015, more than 33,000 Americans died because of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl.
Here are some equally troubling statistics from the National Institute on Drug Abuse:
- Roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them.
- Between 8 and 12% of these develop an opioid use disorder.
- An estimated 4 to 6% of those who misuse prescription opioids transition to heroin.
- About 80% of people who use heroin misused prescription opioids first.
- The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.
- Opioid overdoses in large cities increased by 54 percent in 16 states.
There is evidence the crisis has yet to peak. Emergency room visits for suspected opioid overdoses rose by 30% throughout the U.S. in a year, according to the CDC. The analysis, appearing in a new Vital Signs report, was based on about 91 million ED visits in 52 jurisdictions within 45 states from July 2016 to September 2017 from the CDC’s National Syndromic Surveillance Program (NSSP) Biosense Platform.
So, what is the government doing about it?
In response to the opioid crisis, the U.S. Department of Health and Human Services (HHS) is focusing its efforts on five major priorities:
- improving access to treatment and recovery services
- promoting use of overdose-reversing drugs
- strengthening our understanding of the epidemic through better public health surveillance
- providing support for cutting-edge research on pain and addiction
- advancing better practices for pain management
The National Institutes of Health, a component of HHS, is the nation’s leading medical research agency and is helping by focusing on discovering new and better ways to prevent opioid misuse, treat opioid use disorders, and manage pain. To accelerate the progress, NIH is exploring formal partnerships with pharmaceutical companies and academic research centers to develop safe, effective, non-addictive strategies to manage chronic pain as well as treat addictions and deal with overdoses.
The U.S. Department of Justice plans to hold providers accountable via a new large-scale effort to tackle the opioid crisis. It is certainly easy to hold those writing the prescriptions accountable—at least at first blush. Doctors and other providers are quick to point out that they have been the subject of manipulation by pharma for quite some time. Adriane Fugh-Berman, MD, a Georgetown University professor who leads the PharmedOut initiative, asserts that “the pharmaceutical industry is almost completely responsible for this epidemic”. She went on to cite misleading advertising and pharma’s practice of hiring “thought leaders” to shame providers into prescribing more opioids. These individuals told physicians they were “torturing our patients” by not issuing painkillers whenever they complained of pain. This has been a tactic that I have seen in action, and is deeply troubling. Since the 1990s, physicians who have been reluctant to dole out opioids to those with chronic pain have been label “cruel”, those I always thought the only situation where addiction should not be a concern would be those battling the pain of terminal illness. I was in the minority though.
As they have in other instances, Pharmaceutical companies “spun” the literature by consistently citing small-scale studies and research letters as evidence for supporting opioid prescriptions and publishing ghostwritten articles in medical and consumer publications. Prescribers bear some responsibility also, often writing for doses of opioids that are too high for too long a duration; and though pharma helped ingrain those habits, it is up to providers to be more cautious with the use of such drugs. Fortunately, many physicians are starting to ask themselves hard questions about their own prescribing practices, and states and professional societies are beginning to issue guidelines.
This is a crisis that needs to be addressed, but it is historically marked by extremes. I hope we can address the root causes, without leaving behind those in chronic pain who have no other options.