Understanding the Opioid Epidemic: a Physician’s Perspective
By Dr. Ryan Taylor, Genesis Spine and Joint Health Center
The opioid epidemic continues to ravage many communities throughout our country and unfortunately, the likelihood is high that you or a loved one have in the past dealt with or are currently dealing with an opioid addiction. Opioid addiction can destroy lives, careers, aspirations, and can lead down a devastating path.
Ryan Taylor, DO
In 2016, 42,000 Americans lost their lives to opioid overdose. About 40 percent of these overdoses were from prescription medications and the other 60 percent from illicit use of opioid medications (eg. Heroin). There is a chronic pain epidemic in the United States, with an estimated 116 million people suffering with a diagnosis of chronic pain (defined as pain lasting more than 3-6 months). This number is greater than heart disease, stroke, diabetes and cancer COMBINED.
When comparing data around the world, the United States has a substantially higher number of patients with chronic pain and opioid use. The United States uses 98 percent of the world’s hydrocodone-acetaminophen supply. In 2010, this medication was the No. 1 prescribed medication in the country.
As a specialist in Physical Medicine and Rehabilitation, many if not all of my patients have pain and therefore I have become quite accustomed to the pain discussion and appropriate treatment options. I am a minimalist when it comes to medications and especially narcotic medications, reflecting my training at Mayo Clinic.
Many factors have influenced the current opioid crisis we find ourselves in today. The argument over responsibility of the opioid crisis has been intense. Does the responsibility lie with pharmaceutical industry, physicians or other prescribers, patients, the health care system in general? The answer is yes, to all.
The pharmaceutical industry deserves a large portion of the blame for the current crisis for decades of false information, aggressive lobbying and advertising, and convincing patients that opioid medications are what they need for their chronic pain. This stems back to the developer of OxyContin, Purdue Pharma, originally stating their independent research indicated that this medication was not addictive (which was blatantly false). This either means they had bad scientists or that they knew the addictive potential and did not disclose this. Both of these possibilities are frightening.
Purdue and many other companies have paid billions of dollars in advertising, lobbying, and marketing to infiltrate medical practice and convince the public that opioid medications are the treatment for chronic pain. Unfortunately, their efforts were very successful. While I could continue to write many pages about the pharmaceutical industry’s responsibility and lack of accountability, I will move on.
While patients are responsible for inappropriate use and diversion of opioid medications (this does happen, much more than we would like to think), the majority of patients do not want to be dependent on or addicted to opioid medications. They are simply looking for something, anything to help with their pain.
However, many patients are then unwilling to taper off their opioid medication once it has been initiated, which would be appropriate use in most (but not all) patients. There are likely multiple reasons for this, but a main reason is patients may not receive the appropriate education regarding the effects of long-term opioid use, such as opioid-induced hyperalgesia (more pain) and central sensitization.
As in life, a few “bad apples” have helped create the medical environment in which we physicians now practice. The majority of physicians do not prescribe opioids and, if they do, prescribe only as appropriate, minimizing the dose and duration of the prescriptions. Most physicians who prescribe opioid medications are educating patients about the risks, testing for diversion or abuse, and minimizing dose increases to prevent tolerance and addiction.
However, there have been, and continues to be, a few physicians who have not followed standard-of-care recommendations and prescribed opioids at very high rates, some even operating so called “pill-mills." Many of the very aggressive prescribers have been arrested and prosecuted or barred from practicing medicine; however, there remains a number of prescribers who continue to prescribe opioids at much higher rates and dosages than is indicated by the standard of care.
When a patient starts to develop tolerance (and many do) to their current opioid dose, most physicians would prefer not to increase the dose or frequency as this can lead to worsening pain over time with no better pain control. Since 2012, the number of opioid prescriptions has decreased by 8.1 percent and on a trend of 5 percent decrease every year since that time. However, during that same time period, overdose deaths have quadrupled.
Many patients are “addicted” to the opioid medication and, because of the gateway effect of opioid medications, go looking for other avenues to feed their addiction. This has resulted in the explosion of illicit opioid use. Since 2015-2016, overdose deaths have increased on average 33 percent, but the increase has been much higher in certain areas of the country. Death rates from illicit fentanyl (100x stronger than morphine) has increased 73 percent while prescriptions for fentanyl have decreased. Heroin overdose death rates are up 50 percent. This trend reflects the transition from prescribed narcotic medications to illicit use.
Alternative Forms of Pain Management
While our country is deep into the opioid crisis, I believe there is still hope to rescue lives from the grip of opioid addiction and abuse. Genesis Health System is embarking on a community-wide education campaign regarding opioid medications, as awareness is the first step to solving the problem. We as a health care community need to do a better job of educating you, our patients. You deserve to know what happens to your body with narcotic medication use and why we as physicians want to minimize opioid use as much as possible. We want to encourage patients to have a conversation with their physician or prescriber about the pitfalls of opioid medication and other alternatives.
At the Genesis Spine and Joint Health Center, we focus on treating your pain in a compassionate, thorough, and appropriate manner. Whether you are having joint pain (knee, hip, shoulder, hand, etc.) spine (neck and back) pain, or other pain, we will develop a plan to help you improve your function while minimizing opioid medication use. At the Spine and Joint Health Center, we have many treatment options and will develop an individualized treatment plan specifically tailored to your needs and preferences.
Pain can be a difficult experience, but I want you to know that we are here to help. Genesis Health System is investing in our community to help educate patients on the opioid crisis and provide treatment options with your future in mind. We greatly appreciate the trust you put in us. It is a true privilege to participate in your health care.
Stay strong, be active, and remain determined to better your life. You deserve it.
Need resources? Learn more about opioids and alternative forms of pain management at www.genesishealth.com/Opioid