The Other Side of the Opioid Epidemic

The number of opioid prescriptions per person in the U.S. peaked in 2010. And it has dropped every year since through 2015. This sounds encouraging, but according to the Centers for Disease Control and Prevention (CDC), the level in 2015 was still three times higher than in 1999. And while the U.S. makes up 5% of the world’s population, we consume 80% of the opioid pain relievers manufactured.

So, prescribers are becoming more and more reluctant to write prescriptions for the drugs for fear of investigation, or worse, prosecution and prison. This after increasing attention on the opioid epidemic that has led to policies aimed at curbing prescriptions and dosages, as well as insurers limiting the number of pills they’ll authorize.

In March 2016, the CDC issued stricter guidelines for doctors who prescribe opioids. The guidelines urge doctors to use caution when prescribing opioids at any dosage, especially when increasing dosages, including justifying dosages greater than 90MME per day.

Is this a case of throwing the baby out with the bathwater?

What About Chronic Pain Sufferers?

What about the patients for whom pain is genuine, and often chronic (estimated to be between 25-100 million people in the U.S.)? What about those whose need for pain relief is real? Chronic pain is the primary reason people go on disability. And in addition to overall quality of life, chronic pain negatively effects work, family, and social networks. According to an article posted on the Psychology Today website (11/24/2015), the suicide rate among people with chronic pain is known to be roughly twice that for people without chronic pain.

Is there an epidemic of chronic pain that’s getting little attention in the face of the opioid epidemic?

Chronic pain sufferers are often dependent on opioids to function and live normal day-to-day lives. But being dependent (in order to function) is not the same as being addicted.

Patients who have legitimate needs for opioids are finding it increasingly difficult to get access to their prescriptions; they experience everything from having to drive long distances to find providers willing to prescribe, to having to sign contracts, to being urine tested, to being tapered to lower doses than they need.

What’s the Answer?

These patients, and their doctors, say that the answer to the opioid epidemic is not taking away the medication of every patient out there. It’s addiction treatment. They say there are those who legitimately need pain medication as well as the many options for chronic pain management available to providers. Appropriate use of the correct intervention at the right time must be part of the conversation.

In Idaho, where a “Don’t Punish Pain” rally was held in Boise in March 2018, attendees wanted to have chronic pain sufferers added to a list of cancer and hospice patients. This would enable them to get their pain prescriptions without limitations. Protesters hope that future legislation reflects their needs.

But providers in Idaho write higher than the national average number of opioid prescriptions. According to the National Institute on Drug Abuse, in 2015, Idaho providers wrote 76.4 opioid prescriptions per 100 people. That’s approximately 1.3 million prescriptions. In the same year, the average U.S. rate was 70 opioid prescriptions per 100 people. And in some Idaho counties the rate is even higher.

In an April 2018 interview with CNN, the head of the U.S. Food and Drug Administration, Dr. Scott Gottlieb, suggested mandatory training on pain management and opioid prescribing for the nation’s physicians. He said that current standards are based on outdated training, which is not mandatory and that we need to “re-educate a generation of physicians.”

Idaho is already making efforts in that arena with prescriber education via University of Idaho’s ECHO Program. ECHO uses a team of specialists in a learning and guided practice model – communicating through video conferencing technology to connect with providers throughout the state to conduct virtual clinics. Its first clinic (bi-monthly March through September 2018) is focusing on opioid addiction and treatment.

Chronic pain sufferers and the providers who treat them hope that the pendulum that has swung so far in one direction will come back toward center. They hope that with more research and increasing calls for mandatory education, not only in opioid prescribing but in pain management, the right balance of treating people who suffer from chronic pain will be achieved.

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