Prescription for disaster

Pain medications have become a prescription for disaster for too many Americans.   

According to the Centers for Disease Control and Prevention, every day 40 people die from an overdose of prescription opioids. That is more than daily deaths from heroin and cocaine overdoses combined. 

{mosads}Many opioids are prescribed with the best intentions for patients with pain, but then become gateway drugs, leading to a burgeoning heroin problem. Eighty percent of new heroin users report previous painkiller misuse as a precursor to trying heroin, many switching to heroin because prescription opioids were too expensive.  

Sure. we can crack down on “pill mills,” where unscrupulous doctors peddle painkiller prescriptions. But that alone will not solve the problem. Even physicians with the best intentions aren’t always equipped with what they need to prevent misuse of these drugs.  

The House and Senate Caucuses on Prescription Drug Abuse, along with the National Council for Behavioral Health and the Hazelden Betty Ford Institute for Recovery Advocacy, will host an important conversation today, Oct. 6. Panelists – including providers, elected officials, and persons with lived experience – will highlight the need to expand education for those who prescribe painkillers. 

The timing couldn’t be better. We need a national conversation on prescription painkillers: when to use them; how much should be given to any one patient; when or how non-medication alternatives should be used; how an addiction should be identified; and when intervention is needed to address misuse or addiction. 

Many doctors acknowledge the challenges in answering these questions. We believe there are five ways we could move our nation closer to curbing the opioid epidemic through education and awareness. 

Focus on the whole patient. When prescribers see a patient, they aren’t looking at just a back or knee pain problem, but a person with a whole constellation of health care needs. When you assess a whole person and their situation, you must also recognize the potential for addiction, and consider it as part of the treatment plan.  

Carefully manage treatment plans for acute pain. Prescribers need to assess an appropriate dose for an appropriate length of time for each patient’s unique condition. Follow-up measures need to be put in place so the prescriber can assess how well the treatment plan is working and if and when it might need to be modified. 

Differentiate between treatment for acute pain and chronic pain. The answer to a patient’s acute pain may be a prescription for Oxycontin, but that shouldn’t be the front line of treatment for chronic pain. There is a range of alternatives – physical therapy, acupuncture, massage. Drugs are one tool in the toolbox – not the only option. 

Be aware of the potential for overuse – even unintended overuse. Doctors need to keep closer track of painkiller prescriptions. Most states have these electronic monitoring systems, but we need to encourage doctors to use them more assiduously to see if patients are collecting multiple prescriptions – and to flag if a patient is already taking an opioid and perhaps is unaware or confused. 

Educate the public. Education isn’t only for doctors: Patients need to be sure they understand what they’re being prescribed and be prepared to ask questions if they are not sure. What are the possible side effects? How long will I be taking this? Is there potential for addiction? 

Solutions are already emerging.   

More programs to educate medical students will help, like the initiative by Massachusetts’ top medical schools to establish guidelines to teach medical students to safely prescribe painkillers. New Jersey legislators are considering a patient notification bill that lets patients know about the addictive potential of opiate painkilling drugs. It requires doctors to discuss the risk of dependency before prescribing. Kentucky has enacted comprehensive legislation to implement a tracking database – and then made it mandatory for providers to check it before they can prescribe an opioid. Despite initial pushback from some physicians, KASPER is working – physicians now describe it as a critical tool in their care arsenal. 

On the federal level, the bipartisan Comprehensive Addiction and Recovery Act, authored by Senators Rob Portman and Sheldon Whitehouse, provides money for prevention and education, supporting states in getting engaged in public awareness campaigns and providing desperately needed incentives to support states’ prescription drug monitoring programs. This bill takes a comprehensive approach to dealing with the problem, from prevention to treatment, and richly deserves to pass. 

Opioid addiction is a national crisis, one we cannot afford to ignore. Increased public and prescriber education, more evidence-based prevention programs for youth, supportive public policies, and accessible treatment services are all part of the solution.  

But without widespread commitment and the urgency that any crisis deserves, our communities will continue to pay not only the economic price of crime and other social consequences, but grieve the unnecessary loss of valuable lives.

Rosenberg is president and CEO of the National Council for Behavioral Health; Oz is a cardiothoracic surgeon and television personality; and Motu is vice president of the Institute for Recovery Advocacy, Hazelden Betty Ford Foundation.