According to the Centers for Disease Control and Prevention (CDC), about 130 people die every day in the United States from opioid overdoses. As these numbers continue to rise, the situation has gone from being a problem to becoming a full-blown crisis.
The first wave of the crisis began in the 1990s, with a surge in the prescription of opioids. The second wave started in 2010, with significant overdose deaths related to heroin. In 2013, the third wave began, as overdose deaths involving synthetic opioids have increased.
Causes and solutions
Although individuals need to take responsibility for their own health and addictions, two primary groups have been blamed for the epidemic: 1) manufacturers of opioids and their marketing teams, and 2) physicians, for overprescribing opioids. But it’s clear that synthetic and illegal opioid use cannot be wholly blamed on physicians or pharmaceutical companies.
The federal government has taken some measures to fight the epidemic. In September 2018, the U.S. Department of Health and Human Services (HHS) awarded more than $1 billion in opioid-specific grants to help fight the crisis. The awards supported the HHS’s Five-Point Opioid Strategy, which was launched in 2017. Those five points include improvements in:
- Access to services,
- Pain management,
- Targeting of overdose-reversing drugs, and
- Research on pain and addiction.
Opioid manufacturers — particularly Purdue Pharma, which markets Oxycontin — have been the target of lawsuits by local and state governments. One argument in these lawsuits, which is also targeting pharmacies, is that pharmacies and drug distributors were aware they were selling too many opioid pills but did nothing about it.
It’s important to be aware that some states are beginning to tie opioid deaths to the physicians writing the prescriptions. For example, a California physician had a patient who died from an overdose of methadone and Benadryl. The doctor had written the patient’s last methadone prescription. He was given two weeks to provide a summary of the care he provided, a certified copy of the patient’s medical record, and the possibility of fines up to $1,000 per day if he didn’t comply.
Steps to take
What should physicians know, and do, about the opioid crisis? One step is to follow the recommendations in the CDC’s 2016 guideline for the use of opioids for treating acute pain. These include prescribing the minimum number and potency of opioids necessary to get the patient past the worst of the pain. After that, physicians need to look for alternatives like nonsteroidal anti-inflammatory drugs and physical therapy.
Second, physicians should be aware of the practice of “doctor shopping,” where patients look for multiple doctors to provide them with opioid prescriptions. Some states have established physician drug monitoring programs that can help identify what drugs a patient has had filled in that state.
In addition, it’s important to carefully screen patients. Have staff question new patients about why they want to see a doctor and whether that person is requesting an appointment on behalf of him- or herself, or someone else. People calling on behalf of other adults can be a red flag. So is a patient who refuses to release previous physician records.
Remember, patients need to be educated on the effects of opioids, the importance of not allowing other people access to them and the dangers of opioid addiction. You may want to consider using patient pain management contracts. Some doctors use these to help patients and ensure the patients aren’t selling or giving away their prescriptions. They might require patients to visit regularly for urine tests and pill counts. And some patients may need to be referred to addiction programs, such as Alcoholics or Narcotics Anonymous, as part of their treatment.
Patients typically fall into one of three categories:
- Those whose functioning will be improved with pain medication,
- Those who can’t function without pain medication, and
- Those planning to sell their pain medication.
People in the first two categories may require a great level of evaluation to determine which one they fall into.
Finally, be aware of various local, state and medical association policies regarding opiates. For example, the AMA House of Delegates adopted policies at the 2018 AMA Annual Meeting regarding opioid agonist or partial agonist therapies. And doctors at the University of Chicago Medicine system are developing approaches that include customizing care, cutting the supply of opioids that could be diverted and increasing access to medication-assisted treatment.
An important role
Unfortunately, the opioid crisis shows little sign of going away anytime soon. Physician practices can play an important role in diminishing its impact and helping those afflicted get the help they need.