Monday, June 11, 2018

The Opioid Epidemic: One Man’s Progress Is Another Man’s Pain

June 4, 2018By Michael D. Shaw

On May 31st, The American Medical Association issued a report entitled “Physicians’ progress to reverse the nation’s opioid epidemic.” The key finding is that opioid prescribing has been decreasing for five years in a row (2013-2017). Within this time frame, the number of opioid prescriptions has decreased by more than 55 million (22.2% decrease nationally). And, all 50 states have seen a reduction in these prescriptions over the last five years.

Additional points include:

** Prescription drug monitoring programs are being used to a much greater extent.
** The use of Naloxone—a drug indicated in the treatment of opioid overdoses—has widely expanded.
** There are now more than 50,000 physicians certified to dispense buprenorphine for the treatment of opioid use disorders. This number represents an increase of 42.4% in the past year.

In the press release accompanying the report, Patrice A. Harris, MD, MA, Chair AMA Opioid Task Force, stated: “While this progress report shows physician leadership and action to help reverse the epidemic, such progress is tempered by the fact that every day, more than 115 people in the United States die from an opioid-related overdose. What is needed now is a concerted effort to greatly expand access to high quality care for pain and for substance use disorders. Unless and until we do that, this epidemic will not end.”

No doubt, Dr. Harris’ remarks serve to temper the largely optimistic tone of the report. Yet, it should be noted that deaths from opioid overdoses keep increasing every year. The article linked cites a recent CDC report that contains this rather disturbing observation…

“From 2015 to 2016, opioid-involved deaths increased in males and females and among persons aged ≥ 15 years, whites, blacks, Hispanics and Asians/Pacific Islanders. Deaths involving synthetic opioids increased in every subgroup examined.”

Josh Bloom, Senior Director of Chemical and Pharmaceutical Sciences for the American Council on Science and Health, and friend of this column, is a great source for matters related to the opioid addiction problem. Here are a few of his observations:

“The reasons for opioid abuse are multifactorial, but there is no question that epidemic began to escalate in 2010, not from any crackdown, but from an improvement in the formulation of abuse-resistant OxyContin (still suitable for legitimate pain sufferers, but useless for those who would attempt to grind and inject it) and the unintended consequences that followed. This is indisputable. Despite seven years of increasing ‘vigilance,’ the number of deaths caused by prescription pain medications remains unchanged, yet total opioid overdose deaths have increased dramatically. The reason is obvious.”

“Virtually all of the additional overdose deaths since can be accounted for by increased use of heroin/fentanyl. Prescription pain medicines are much more difficult to get than seven years ago, and the only result has been suffering by pain patients and no benefit. It could be no other way. Pills are not the primary driver of overdose deaths. They never were.”

But, the AMA is so proud of the fact that opioid scripts are way down. What happens to the chronic pain patients who need these drugs? Put concisely, nothing good. Last summer, Bloom interviewed Aric Hausknecht, MD, neurologist and a specialist in pain management. Hausknecht painted quite a depressing picture…

“It is very disconcerting to a patient that relies on pain medications to function on a day to day basis to worry about whether or not he will have his medications in the future…It is a cruel and unusual punishment to deny these patients access to opioid analgesics.”

Hausknecht notes that many physicians have stopped prescribing opioids altogether. Thus, he gets plenty of calls from desperate patients. As to those prescription drug monitoring programs mentioned earlier, they seem to be a wee bit intrusive. He refers to New York state laws that mandate an extremely cumbersome system to e-prescribe, and then limits the size of prescriptions. Bloom has heard of too many “Dear Colleague” letters being sent to docs who might be prescribing too much—at least in the minds of Big Brother.

Quite sadly, this is just trashy politics. After all, even if the unintended consequences are enormous; and mostly innocent people are the ones being hurt; not to mention invoking autocratic control of physicians; think of how good it looks on the evening news. “Something” is being done about the opioid epidemic.

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