Tweet This
This post was contributed by Gerald McKenna, MD, a board member of the Physicians Foundation and the CEO and Medical Director of his private practice in Addiction Medicine, McKenna Recovery Center.
The United States is in the midst of an opioid crisis unlike anything we have seen in medicine since the HIV epidemic in the 1990s. Imagine, the U.S. has five percent of the world’s population but uses 50 percent of the world’s opioid analgesics. In 2017 alone, an opioid overdose was the cause of more than 60,000 deaths —quadruple the number of deaths since 1999. This death rate continues to increase and shows no signs of slowing.
In order to understand the origins of this opioid epidemic, we need to go back to the early 1990s. New guidelines on analgesic treatment and quality assurance issued by the U. S. government (1995), the American Pain Society (1995), and the World Health Organization (1996) tell the story.
There was a movement to treat pain more adequately than what had been done in prior decades. Pain was to be labeled as the fifth vital sign in medicine, in addition to blood pressure, pulse, respirations, and temperature. As a result, physicians were ordered to adequately evaluate and address pain in their patients. As part of this order, there was a requirement in California to obtain at least ten Continuing Medical Education (CME) credits per year to ensure that all physicians with a California license adhered to the new policy. Physicians who did not comply or who had complaints against them for inadequate pain control were sometimes referred to peer-review committees to have their noncompliance evaluated.
The new recommendations appeared successful and were quickly adopted nationwide. It was not unreasonable to expect that a trained physician would be able to determine the origins of pain and provide adequate treatment for it. Thus, the production and sale of short-acting opioids increased dramatically.
Unfortunately, the CME courses that were offered to physicians attempted to address the proper prescribing of opioids, but did not necessarily emphasize the use of non-opioid approaches to treating chronic pain.
As the opioid crisis has reached a climax, physicians have been forced to look carefully at their prescribing habits. Physicians' continuing medical education programs are now deemphasizing the use of opioids in all but acute pain, such as for postsurgical analgesia.
A corollary to this reeducation and reconsideration by physicians is the challenge to help reduce opioid use for patients who have been placed on very high levels of opioid analgesics for years. This is an incredibly important task – to reverse the alarming opioid crisis we find ourselves in today as a country.
The Physicians Foundation, of which I am a board member, was established to aid physicians in dealing with serious emerging problems in our healthcare system. The opioid crisis is an issue the Foundation recognizes as a critical one that must be addressed. That begins with properly educating our physicians, then treating patients using effective and safe means.
There are a series of actions that need to be taken if we are going to affect the opioid crisis.
- Educate physicians, nurses, pharmacists, medical students, residents and the public on the treatment of acute and chronic pain.
- Pharmaceutical companies need to recognize their role in creating this crisis and work with the medical profession to address it.
- Educate patients regarding treatment approaches to both acute and chronic pain.
- Implement a group model for patients who present to primary pain clinics with complaints of chronic pain. This model is well suited to educate patients regarding the clinic’s approach to the use of opioid analgesics, central and peripheral mechanisms involved in pain, non-medication approaches to pain and empowerment to support each other in dealing with chronic medical conditions involving pain.
- Encourage physicians to take the online training in the use of buprenorphine, an often lifesaving medication.
In a similar vein, addictionists have come to understand that the physical and emotional reaction to chronic drugs can easily lead to a chemical use disorder, the term used to describe the chronic medical conditions formerly called addiction or drug dependence. There has traditionally been inadequate training in medical schools and residencies regarding the diagnosis and treatment of chemical use disorders, but the American Society of Addiction Medicine has provided many educational opportunities online and in courses around the country to train physicians in the recognition, early treatment, and referral for further intervention of these chronic medical illnesses.
Physicians need to be trained in the early signs and symptoms of chemical use disorders, including drug-seeking behavior, physician manipulation, seeking prescription from multiple physicians, and using emergency rooms and urgent care clinics to obtain opioid analgesics for non-existing or minor injuries.
Our health care system needs to be revamped to provide this equal recognition. Without these changes, chemical use and psychiatric disorders will always be sidelined and will not be recognized as chronic medical problems in need of equal treatment.
The opioid epidemic is vast and increasing. We have the tools at hand to be able to successfully intervene in this serious medical problem. It will take congress and the will of the people in pressuring our congressional leaders to support the readily available solutions to this deadly problem.
