Overprescribing is one of the leading culprits in the current opioid crisis across the world.

According to the US National Library of Medicine, ‘misuse of prescription opioids and heroin affects more than 2 million Americans and an estimated 15 million people worldwide each year.[1]

The danger of prescribing opioids is that they have a lot of potential for misuse and abuse. Tolerance builds quickly, and overuse leads to dependence, which in turn leads to addiction. Opioids are meant to be used in the short term to treat acute pain conditions, or after surgery. There are no proven benefits of long-term opioid use. When opioids are prescribed to alleviate pain related to a long term, chronic condition, addiction is highly likely.

Overdose of opioids is far too easy, as tolerance builds quickly so more of the drug is needed to feel the effects. Opioids slow your heart and breathing rates, so too heavy a dose and the consequences can be fatal.

Why are opioids being overprescribed, and what can we do about it?

There are a number of reasons why opioids are prescribed at such high rates. Many place blame on doctors for being reckless with prescriptions, but it’s important not to place too much blame on any one factor as the reasons are varied and complex.

One contributing factor is the culture of medicine that we live in. There is often emphasis on the need for pain medication to eliminate any pain that a patient may be experiencing. An unwillingness in patients to deal with even mild pain, and instead mask it with medication, leaves physicians under a high demand to treat any sign of pain, which is most efficiently achieved by the use of strong opioid painkillers.

Many opioid prescriptions originate in the emergency department.[2] In these circumstances doctors don’t have a lot of time to fully assess a patient’s pain and experience relating to it. They don’t have that time that is so important to understand the patient’s history and risk of addiction. Evaluation is often based on the quantity of patients treated rather than the quality of treatment. On leaving the emergency department, patients are often requested to respond to a satisfaction survey concerning how effective they believe their treatment was. Part of a doctor’s evaluation concerns how these surveys are scored, which provides an incentive to treat pain as quickly and efficiently as possible.[3]

Further emphasis could be placed on the importance of appropriate training for prescribing opioids. Unfortunately, doctors receive little treatment in how to safely manage chronic pain and treat addiction.[4] One solution to the opioid crisis then is to encourage better education for doctors in terms of addiction prevention and treatment, recognising risk factors, and safely prescribing medication.

One of the major contributing factors to the opioid crisis and the overprescribing of medication is the influence of pharmaceutical companies. Physicians are rewarded with gifts and payments in turn for prescribing a specific medication. In a report by ProPublica in 2016, researchers found that the more doctors were paid by the industry, the more they prescribed brand name drugs in general.[5] There is no benefit to this other than profit. It does not serve patients’ best interests in any way and so needs to be stopped.

The reasons for the opioid crisis and why there is so much overprescribing in medical practice are varied and complex. Time constraints in practice, miseducation about addiction and pain management, and the financial influence of pharmaceutical companies all play a role in how the crisis developed. But as normal person, not a doctor or a CEO or even anyone employed in the field of healthcare, how can we as individuals tackle the problem? The first step is education.

Patient Self-Advocacy

Prescribing opioids should be done only when the doctor has an awareness of your health status and your risk of addiction. Factors that play a role in your risk of developing an addiction include: a history of substance abuse, childhood trauma, depression, and character traits like impulsivity. The risk is also higher for those living in poverty or in rural areas, and those who associate with others who misuse or abuse substances. Each individuals risk of addiction is determined by a mix of social, economic, health, and lifestyle factors, so it’s best to advise your doctor about any potential risks that you’re aware of before beginning a course of opioid medication.

Patients can benefit from being their own advocates when it comes to medical care by educating themselves on their condition and the medication that they are being prescribed. Many patients blindly follow a doctor’s directions, offloading their care completely to the hands of the doctor. This isn’t always a smart choice, as doctors are often under a lot of pressure to see and treat many patients, with more focus on quotas than quality of care.

Add to this the influence of pharmaceutical companies and behaviour of peers, and the chance that your doctor will prescribe you strong pain medication to alleviate your pain is high, even if that medication isn’t the best choice for you.

Patients can advocate for themselves by speaking up and not being afraid to ask questions or raise concerns, and by doing some research on their prescribed medication, considering the risks and the responsibilities associated with taking it, and exploring alternative treatment options if you feel that a certain medication isn’t for you.