Epidemic. Crisis. Outbreak. Call it what you want, but the current opioid addiction is the worst in American history. Drug overdoses claim 64,000 lives every year. That is 175 a day! Almost everyone has been affected, family or friends.
There have been arrests - 60 people across five states, including more than 31 physicians, seven pharmacists and eight nurses - and lawsuits against drug distributors, opioid manufacturers, and pharmaceutical companies.
The pharmaceutical manufacturers and distributors were charged for years of deceptive marketing about the risks of opioids, and failure to prevent the drugs from getting into the wrong hands.
Those arrested, most of them doctors, were behind both illegal and over-prescription of the drugs, accounting for around 350,000 prescriptions and 32 million pills. There is also "opioid diversion", a case of legally prescribed opioids that are stolen, where again doctors and nurses are said to be responsible.
The doctors involved were indicted for various schemes including prescribing opioids for gratuitous medical procedures, like unnecessary tooth extraction. Some of these doctors handed out signed blank prescriptions, or simply passed out prescriptions without even going to the trouble of disguising their purpose.
For causing an outbreak in opioid addiction and deaths due to overdose, the ax has already fallen on those “rogues in white robes.” However, there are still good doctors who remain committed to the noble profession of saving lives, and they’re beginning to speak out.
Dr. Fiona Webster (@FionaWebster1), associate professor at the Western School of Nursing, concluded a study that pointed to the opioid crisis also leading doctor burnout.
Webster said opioid pain medication was the first line treatment for chronic pain.
In the absence of opioid, there are no well-funded alternatives for doctors to offer patients, like physiotherapy and massage, which can only be taken up by wealthier patients.
“If there aren’t better supports for physicians and patients we are going to see growing rates of addiction and suffering amongst patients, and we are also going to see rising rates of physician burnout in the future. So it’s a lose-lose situation for everyone,” she said.
As part of her study, Webster spoke to over 60 physicians about the opioid crisis how it is affecting not only patients but doctors as well.
Below are the concerns, perspectives, and positions related to the opioid crisis we’ve curated from five of these doctors.
To best help patients who are suffering from pain or addiction, doctors don't need more rules. They need more options. Just addressing opioid prescribing by itself is extremely diverse. How do you treat a patient who is opioid naive and has his or her first surgical procedure... versus a patient who's been on opioids for years for chronic low back pain... versus an acute or chronic painful condition in a patient who has a substance use disorder? There is no one guideline by any one organization that will ever be sufficient. If we treat pain better, with all the options available to us, then patients will not have to rely on opioids as their only method of managing pain. - Ed Mariano, M.D. (@EMARIANOMD)
We overprescribe opioids, just as we overprescribe antibiotics. But it is generally well-meaning; we don’t want our patients to experience pain...The role of these physicians can best be described as an innocent bystander. We were truly trying to help the patient. - Ronald Hirsch, M.D. (@signaturedoc)
Are we writing too many opioid prescriptions? The answer is obviously yes. Every patient’s needs are different, and some will require more opioids for a longer duration than others. Our ultimate goal is to personalize this process by predicting the best treatment path for each patient and each surgery. - Sean Mackey, M.D. (@DrSeanMackey)
Neither the policies of yesterday nor those of today can be entirely rational. The scholarly literature tells us that is reality. Our task was to explain how our collective irrationality has changed over time when it comes to opioids.
The new prescription control framework is a funhouse mirror image of the prior monopoly. What was virtuous under the prior regime was to chase a number — the pain score — using opioid prescriptions, even as naysayers pointed out that people were being harmed. What is virtuous under the new regime is to chase new numbers — opioids prescribed — even as naysayers point out other people harmed. - Stefan Kertesz, M.D. (@StefanKertesz)
Our current problem came about from physicians ultimately wanting to do the best for the patient, relieving pain. But pain is a complex experience, and not all pain needs to be addressed by using opioids...each situation is different and treatment needs to be individualized. This crisis has to be addressed on a number of levels:
in an acute setting, we have the responsibility to treat pain appropriately.
we have to provide patients with appropriate expectations regarding the time frame with which opioids will be prescribed in every setting, as best we can.
we need improved communication with our patients regarding the pain experience and focus on return to functioning, despite unresolved pain.
we must communicate that nonpharmacologic treatments for pain can be effective and part of a thoughtful pain management plan. - Tracy Harrison, M.D. (@drtracyharrison)
As we’ve learned from experience, the crisis started from opioids being taken without proper supervision. Left unchecked, it caused an outbreak in opioid addiction that led to overdose-related deaths.
This makes communication key in medication management. Not only does communication educate patients helping in their management, but more importantly it fosters key patient-doctor engagement, where the correct treatment is the shared desired outcome.
An active communication line between the patient and health provider, even the whole care team, can be enabled in a patient engagement platform. To know how the technology in your hands can be a tool for patient safety, check out LifeWIRE today.