A blog by Dr Colleen Kelly PhD, MFT
Over two million US residents are addicted to opiates, and almost 600,000 are addicted to heroin. Less than 20% of those get the treatment that they need. Approximately 80% of the world’s opioid prescriptions are written and filled in the US. There is no silver bullet for the opiate crisis in the US, but there are crucial steps that we need to take to over come it. Other countries can learn from our mistakes and better prepare for the day the opioid crisis reaches their shores because it is coming.
The most important thing we can do right now, that is very doable and not hard to execute, is to triage the opioid addiction crisis. First, make sure that every EMS worker and police officer carries Narcan (naloxone). The drug Naloxone is the opiate antidote that saves lives. Naloxone has been highly successful in reversing an opioid overdose by putting the individual into withdrawal. Lay persons can also carry the pocket size Narcan device that contains an injectable form of naloxone or the new nasal spray version that requires no training to administer.
Another battle we have in overcoming the opioid epidemic and rash of overdose deaths is ignorance. Take, for example, Butler County, Ohio. Butler County is being decimated by opioid deaths. The sheriff of Butler County has publicly decided to forbid the use of Narcan by his officers because he believes that it “enables addicts” and he further says that the $37.50 Narcan is too expensive to administer repeatedly to the same person. The callousness and astounding ignorance of this rationale has been repeated by several other high ranking officers in law enforcement across the country. If $37.50 is too expensive to pay to save someone’s life three times, which heart attack will be considered the one that we administer no medical care and let the patient die — the third or sixth one? Or maybe EMS will leave people to die the second time they are called if they heard that the patient ate fries and lasagna that day? Whether or not to use a life-saving drug that costs $37.50 on a dying patient should be a non-discussion, but it illustrates the vast amount of addiction education that we still need to do in the US.
Concurrently with continuing to improving public awareness, especially those working in the public sector, we need to educate more doctors and pharmacists about addiction and chronic pain. Many physicians are not aware of the high risk of opioid addiction. No one is suggesting withholding pain medications but before surgery all patients should have a talk with their doctor about what they are prescribing for pain post surgery. Frequently opioid painkillers are being given to people for everything from wisdom teeth to hip replacements. One study at the Mayo Clinic revealed that 21% of patients meant only to receive short term opioids post surgery ended up with prescriptions that extended up to 4 months while another 6% had over 6 months of opioid refills given to them. Some doctors now insist a patient begin tapering off pain medicine after surgery and switch to non-steroidal anti-inflammatory drugs and using ice on the affected area or a cooling machine. It is also crucial that patients share their medical history regarding smoking, drinking and drug use with their doctors. A history of depression or a mood disorder may also make a patient more likely to abuse their pain medication.
Teen opioid addicts report their first opioid pills were given to them by a doctor. Prescriptions for opioids have quadrupled since 1999 and along with those numbers opioid deaths due to overdose have also quadrupled since then. Misinformation, lack of information, and aggressive marketing to physicians has taken its toll.
There has to be more oversight of drug companies who develop these medications, and the companies who profit so much via the epidemic should fund research into pain and opioid use. We must significantly reduce the number of unnecessary painkiller prescriptions. Insurance companies need to reimburse their members for cost-effective pain management, including non-drug treatment. Treatment needs to be made readily available for all people regardless of ability to pay in hospitals, jails, and treatment centers. There must be funding for opioid treatment programmes and sustaining rather than cutting funding for healthcare because people who are addicted to drugs need comprehensive health care to provide safe detox, to address many of the contributing causes of addiction, and the lasting effects on the body.
By triaging the growing crisis and dramatically reducing deaths from overdosing, viewing addiction as the medical disease that it is, and building an infrastructure in the US to handle the vast size of the epidemic, while simultaneously focusing on education and treatment accessibility, we can make a difference in the number of overdoses and new addicts we see dramatically escalating every year.
Dr Colleen Kelly will next be speaking at iCAAD Stockholm on the 21st February, 2019.