Dr. Sanjay Gupta, the Chef Medical Correspondent for CNN, recently wrote that overdoses are the most common cause of preventable deaths in America today. In addition, the 2016 presidential primaries have highlighted states where opioid addiction and related deaths are their governments’ number one concern. Although drug dealers are part of the problem, we are reminded that doctors have contributed significantly to this issue. How could this be? How could those committed to healing the sick and prevent deaths actually be contributing to the rising death tolls associated with opioid addiction? And if physicians are such a significant part of the problem, how can they become a significant part of the solution?
The first question to be answered is: “How can both acute and chronic pain be best managed?” The correct answer is always the same – 'to prescribe the least addicting pain killer for the shortest period of time.' But, in reality, multiple prescriptions are written each day for patients’ office visits, ER encounters, and hospital discharges and for as much as a 30 to 90 day supply of opiates, occasionally with multiple refills. Gupta wrote, “physician's must end these prescription practices which have contributed to the drug death epidemic”. This is the first and most important role for physicians in addressing the problem, i.e.…proper management of prescriptions by physicians to ensure that they are not making the problem even worse.
Second, physicians must insist that pharmacy companies stop directly marketing to patients that imply opioids as a panacea. Just as tobacco companies have been forced to be transparent about the proven addictive properties of tobacco, pharmaceutical leadership must be held accountable for their marketing and promotion materials and techniques. They must declare, both verbally through their sales forces and in writing in their promotional material that opioids are addictive, They must also recommend that opioids be used only when absolutely necessary and for the shortest period of time. Physicians and nurse practitioners are the only ones that have prescribing rights, and therefore have the appropriate leverage with those who manufacture and sell the drugs. They must use it!
Third, physicians must learn and practice better non-addictive ways to manage pain, including the use of proven medical devices, non-traditional medical protocols, and a myriad other approaches already utilized in pain clinics today. This requires that physicians are committed to life-long learning and stay current with the best practices for pain management.
Fourth, physicians and other practitioners along with pharmacy companies must partner to lobby insurance companies and other third-party payers, including Medicaid and Medicare, to pay for long-term pain management. Payment reform will drive best practices. Current reimbursement is sorely missing the boat for many needed therapies, including pain management and outpatient and inpatient addiction programs.
And finally, physicians must recognize the signs of addiction when taking a history, doing the physical, or the red flag when patients request pain medication at the end of their visit. Prevention and treatment cannot occur without first recognizing the problem. Then the steps to address the problem, outlined above, can be implemented.
In concluding his paper, Dr. Gupta said what we all know - we have a long way to go to solve the opioid crisis. Why?
- Patients are now being offered expensive new medications that only treat the consequences of the opioid epidemic, and do nothing to reduce it
- With 259 million opioid prescriptions written yearly, it turns out side effects – such as constipation – are big enough to warrant its own TV advertisement which is selling another drug to address the constipation without mentioning the potential addiction characteristics of the opioids.
We should not be surprised! A recent study showed that 91% of people who survived overdoses were able to obtain another opioid prescription
And now, an article published in response to Dr. Gupta’s report, entitled, “Addicted Doctors Fear Retaliation if They Seek Treatment”. It is well known and accepted as fact that a number of physicians and practitioners have an addiction problem. After successful treatment and a return to clinical practice, it would seem that the practitioner who is a former addict would be the best physician to address the problem of practitioner abuse and drive to solutions. However, it has been reported that they are often reluctant to recommend to others to seek treatment. This is frustrating indeed.
Sadly, I have to agree with Dr. Gupta’s concluding remarks: “it seems we are turning a blind eye to the tragedies unfolding in front of us”.