Solving the prescription opioid problem

English: Drug overdose
English: Drug overdose (Photo credit: Wikipedia)

I’ve posted several times recently on the problem of opioid over-prescription and overdose.

Some might assume that I want some regulatory or statutory intervention to address the issue. Truth is, I’ve got more questions than answers and I would not support a response that forces us to choose between treating pain and preventing addiction and overdose.

It appears that opioids are a great solution to acute pain but a lousy treatment option for chronic pain. (Though,  they may be the least bad option.)

I’m not an expert on policy in this area, just an observer. But, my first thought is that The Joint Commission played a huge role in shifting pain treatment and that they may be a good way to change the behavior of prescribers and health systems.

The big difference this time is that PHARMA provided some wind at the back of those system changes. Other than medical cannabis, it would seem that the wind would be working against us this time. (Though, there is research being done on different delivery strategies for cannabis and its relative effectiveness.)

The current state of pain management is especially bad for addicts. It leads to bad care, neglect and stigma. Even addicts who really want non-opioid, but effective, pain management get brushed off as drug-seeking.

This feels like I’m stating the obvious, but it would seem that we need more education research on non-opioid treatment options, better access to the ones that already exist and better engagement strategies for the existing behavioral strategies.

Balancing pain management and public health

Advertisement for curing morphine addictions f...
Advertisement for curing morphine addictions from Overland Monthly, January 1900 (Photo credit: Wikipedia)

I blogged before about the availability of opiates for pain management and the need to try to limit their diversion. While others have complained about draconian limitations on the prescribing of opiates and being too afraid to treat pain, I pointed out the explosion in opiate prescriptions and overdoses. It’s a complex problem that demands a solution that balances the needs of pain patients with the public health risks of easily available opiates.

Here’s a new study looking at the issue [emphasis mine]:

While overdose death rates related to heroin, cocaine, sedative hypnotics, and psychostimulants increased between 1999 and 2009, deaths related to pharmaceutical opioids increased most dramatically, nearly 4-fold. In 2000, the Joint Commission on the Accreditation of Health Care Organizations introduced new standards for pain management which focused on increased awareness of patient’s right to pain relief which contributed to an increase in prescribing of opioid analgesics (Phillips, 2000 and Federation of State Medical Boards of the US, 1998). The average milligrams of morphine prescribed per patient per year increased more than 600% from 1997 to 2007, which led to an increased availability of pharmaceutical opioids for illicit use (US Department of Justice, 2012). From 1999 to 2007, substance abuse treatment admissions for pharmaceutical opioid abuse increased nearly 4-fold and emergency department visit rates related to pharmaceutical opioids increased 111% from 2004 to 2008; visit rates were highest for oxycodone, hydrocodone, and methadone (SAMHSA, 2009aSAMHSA, 2009b and SAMHSA, 2011). Risks associated with pharmaceutical opioid related overdose included taking high daily doses of opioids and seeking care from multiple healthcare providers to obtain many prescriptions (Paulozzi et al., 2012 and Hall et al., 2008). “Doctor shopping” has also been associated with opioid diversion and illicit use (SAMHSA, 2010 and Rigg et al., 2012). National survey data showed that 75% of pharmaceutical opioid users were using opioids prescribed to someone else (Substance Abuse and Mental Health Services Administration, 2010).