Holding doctors accountable for ending the opioid epidemic

The Senate is poised to act on bipartisan legislation to address the growing epidemic of opioid abuse in the U.S. President Obama has asked Congress to approve more than $1.1 billion to fight the growing epidemic of opioid abuse in America, and there are signs of strong support for these proposals on Capitol Hill. Leaders from both political parties should be praised for their actions.

As a physician, I have seen first-hand the enormous power of treatment to restore health and hope to patients and their families. We must expand access to high-quality addiction treatment – not just for opioids – at all levels of society. This is an important investment but we cannot simply treat our ways out of the opioid epidemic.

{mosads}To truly conquer the opioid epidemic we must do much more about preventing addiction before it starts and physicians and other caregivers must play a leadership role. In October, the president issued a memorandum requiring doctors working for the federal government to receive more training in prescribing opioids. That sets a great example for the profession and more needs to be done. The Centers for Disease Control and Prevention (CDC) recently convened a panel of experts to develop guidelines for all primary-care physicians in the country to help them change their treatment and prescription practices. This includes ordering non-opiate therapies whenever possible, putting patients on the lowest effective dose of a needed opioid for the shortest possible time and screening patients to ensure they are not abusing alcohol or drugs. These steps would improve the prescribing practices of primary care doctors and help them set and hold to boundaries with their patients.

These guidelines and changes in behavior are profoundly needed. Within the past decade we’ve seen an exponential increase in the number of people seeking treatment for opiate addiction. According to the CDC, prescription opioid sales in the United States have increased by 300 percent since 1999, and almost 2 million Americans, age 12 or older, either abused or were dependent on opioid pain relievers in 2013. Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. According to the CDC, Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers and 10,574 overdose deaths related to heroin in 2014.

I don’t believe my fellow physicians had ill intentions but we played a significant role in creating a perfect storm for these tragic consequences to unfold. Too many doctors turned to opiates when alternative pain treatments were available. And too many patients demanded a prescription for one of these powerful drugs based on incomplete information and an understandable need to control their pain. That places doctors in a tenuous position. If they refuse to prescribe an opiate their patient might very well hop to another office until they get what they want and their continuity of care is broken.

That’s why it’s critically important that the medical community play a significant role in creating meaningful change. Our goal as physicians must be eliminating irresponsible prescribing of opiates while allowing our patients’ pain to be appropriately treated.

Primary care doctors are on the front lines of this epidemic but specialists have a role, too. For example, ob-gyns can, and should, look for alternatives to Vicodin for a new mother in recovery from a Cesarean. All physicians should make sure to discuss a patient’s drug and alcohol history to help inform prescribing patterns. Patients with a history of drug or alcohol abuse are at particular risk of becoming addicted to opioids. Before prescribing an opiate, doctors should perform toxicology testing to avoid the dangerous interaction of illicit and prescribed medications. Finally, medical schools and residency programs need to mandate education about these guidelines as part of physicians’ maintenance of certification.

The opioid epidemic is the product of many years of neglect but we don’t have that long to reverse its course. Leadership from the highest levels of government is an important element to this response but ultimately it is the responsibility of the medical profession to heal the ills that are plaguing our society.

Garbely is the medical director at Caron Treatment Centers. Caron, a Pennsylvania-based not-for-profit, has been providing behavioral health and addiction treatment for more than 60 years.