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Opioids

Opioids (1)

02 Nov

A portion of this editorial was published in the Milwaukee Journal Sentinel's Letters to the Editor section on Monday, March 21, 2016:

The Centers for Disease Control and Prevention’s new prescription guidelines strongly urge physicians to cut back their use of opioid painkillers in the treatment of chronic pain. Specifically, the CDC guidelines outline a multidisciplinary approach that includes interventional pain management, behavioral and exercise therapy, and limited use of immediate-release opioids instead of extended-release or long-acting opioids. This is long overdue. The prescription of opioid painkillers has risen fivefold in the last 20 years, and opioid abuse statistics have paralleled that rise. In fact, opioid deaths — including from heroin — reached a record 28,647 in 2014.

Dr. Jeremy Scarlett
  Dr. Jeremy Scarlett

Prescription painkillers directly account for almost 60% of that total and, as a “gateway” drug, indirectly account for a much higher percentage. All too often, addicts first become hooked on legally prescribed opioids like OxyContin and Percocet before switching to the cheaper option, heroin, after their prescription lapses.

Clearly something has to be done about this epidemic. 

Though nonbinding, the CDC guidelines will send a strong message to physicians and others in the medical community. But that is just the first step. As the Journal Sentinel noted, CDC director Dr. Thomas Frieden also pointed out the role of patients in solving this problem. In the immediate gratification culture of American society, many choose to forgo long-term solutions in favor of the quick fix provided by opioids. Frieden acknowledged that many patients try to pressure physicians and clinics by posting negative reviews on websites like Yelp or RateMD, or by complaining on social media that their pain issues weren’t taken seriously. Medical providers must resist this pressure.

We need to challenge our patients by counseling them on the dangers and limitations of opioids and advocating for long-term solutions through interventional procedures and lifestyle changes. Likewise, we should advocate with our lawmakers for expanded drug abuse prevention and education programs that recognize the connection between prescription drugs like OxyContin and street drugs like heroin. Reducing the demand for these drugs is as critical as reducing their supply.

I applaud the CDC for raising awareness of this issue and agree with their analysis. Namely, while opioids do have a place in the spectrum of medical care, they should only be used on a short-term basis and in responsible doses for patients who’ve tried other approaches first — and with safeguards like toxicology screenings in place. Unfortunately, guidelines for the medical community alone are only the first step. We must be increasingly vigilant in raising awareness of opioid risks among the general public. That second step will be even more critical to ending this national epidemic.

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