recommending physical therapy, massage therapy or other holistic approaches to pain management in conjunction with or substitute of opioids when possible.
Hawaii physician Nestor Herana said “Prescriber education is vital in the solution to this epidemic. Physicians need to educate themselves in the proper manner to prescribe opioids. Overprescribing can be dealt with by learning how to prescribe opioids cautiously and rationally. Pain management can be part of a multi-faceted comprehensive plan with emphasis on risk assessment and risk reduction. Having an exit plan is key before the start of any opioid therapy.”
Dr. Herana admits that physicians are partially responsible for making opioid addiction an epidemic as prescribers. He mentions two parts of the primary problem: opioid overprescribing and inappropriate opioid use.
“The medical system overall is the culprit. Medical schools and training institutions failed to educate young physicians how to prescribe opioids safely and how to treat pain appropriately. Pain specialists access is often a challenge to primary care providers. Furthermore, pharmaceutical companies have been found liable of advertising opioids to providers in deceitful methods. The medical culture of well-intentioned but imprudent marketing such as ‘pain as a fifth vital sign’ may have also reinforced opioid misuse and overprescribing,” said Dr. Herana.
The pharmaceutical industry, the source of opioids, have been publicly criticized for promoting misleading advertisements on the addictive nature of opioids. Government officials say the industry must take on greater responsibility. The Food and Drug Administration said it will require drug manufacturers to better educate physicians on painkillers, pain management and non-drug therapies.
The U.S. Justice Department announced it made a $35 million settlement with Mallinckrodt Pharmaceuticals that was alleged to be ignoring evidence when it had reason to believe some of its opioids were landing on the black market.
In addition to the financial cost, the Justice Department also required Mallinckrodt to begin tracking its drugs as they move through the supply chain. Government officials believe this tracking system, if made as a requirement to other manufacturers in the industry besides Mallinckrodt, could help to clean up illegal channels in the flow of drugs.
U.S. Rep. Tulsi Gabbard (HI) said “As we look at treatment options and support for those dealing with this addiction, it's important that we actually focus on the root cause of the problem. We have seen for decades how major pharmaceutical companies have lied to the FDA and the American people about the addictive nature of drugs like OxyContin and the risks of opioid dependency, all to increase their profits. They must be prosecuted for their actions that have led to countless opioid-related deaths, addiction, and suffering.”
The state of Ohio, Mississippi, and other cities and counties have started litigation against pharmaceutical companies over the opioid crisis. The growing movement to hold the pharmaceutical industry accountable is beginning to look like the legal class action suits launched by U.S. states against the tobacco industry in the 1990s where settlements totaled more than $200 billion nationwide.
Trend of Opioid Addiction
Greater public awareness of the dangers of opioid addiction has led to some positive trends. The Centers for Disease Control and Prevention found that the amount of opioid prescriptions has peaked in 2010 and fell by 18 percent since then. This correlates to the slowing down of overdose deaths from legal prescriptions.
But street heroin use has skyrocketed. Fatal overdoses of heroin went from 8 percent in 2010 to 25 percent in 2015, nearly tripling.
The drop in opioid prescriptions and deaths, and rise of heroin use suggest a trend moving from less prescription dependence to illicit street use.
More physicians are also recognizing early patterns of addictive opioid behavior in their patients.
Dr. Herana said “Opioid abusers are faced with a variety of challenges such as but not limited to behavioral health issues, low income social status, geographical location, accessibility to opioids, weak emotional support system, and domestic violence issues. Prompt recognition of aberrant behaviors are important so that critical steps can be made before dangerous situations arise. When an atypical behavior is discovered, prescribers should be empathetic in managing opioid misuse. A rational approach of tapering or discontinuing opioids should be implemented. Proper referral to detoxification and rehabilitation programs must also be adopted by physicians dealing with the patient afflicted with opioid addiction.”
Dr. Patrice Harris, former chair of the American Medical Association, said “One key to bringing down the death toll is to spread the word that addiction is a chronic medical condition, not a personal failing.
Trumpcare Can Hamper Progress
Democrat and Republican governors warned that should President Donald Trump’s American Health Care Act (AHCA) pass to include cuts to Medicaid, this could block Medicaid recipients from getting the opioid treatment they need.
“We’re kidding ourselves if we don’t think what’s happening with healthcare in Congress right now is affecting this issue,” North Carolina Governor Roy Cooper, a Democrat, told his counterparts at a meeting of the National Governors Association in Providence.
“We cannot have millions of Americans lose their health coverage and still effectively attack this crisis. We can’t significantly reduce Medicaid spending and still be successful in fighting opioid addiction.”
On AHCA, U.S. Rep. Gabbard said “Addressing the opioid epidemic requires expanding healthcare coverage, not cutting it back. The Republicans’ disastrous healthcare bill would make devastating cuts to Medicaid coverage, threatening the health of millions of vulnerable Americans, and shifting costs to state and local governments that already face tight budgets. The Senate is split on how to move forward with this legislation, and it is more important than ever that people in Hawaii and across the country speak out and let our nation’s leaders know that they will hold them accountable for this terrible bill. I will strongly oppose this bill if and when it comes back to the House, and continue to do all that I can to defeat it.”
The U.S. Senate recently failed to pass AHCA or repeal Obamacare. But AHCA could be taken up again. For now, Medicaid recipients addicted to opioids could get the professional help they need.