Cutting Off the Opioid Crisis at the Root
By Maura Healey
It’s been nearly two years since the state declared prescription-drug and heroin addiction a public-health emergency. Since then, we’ve had an all-hands-on-deck approach from lawmakers, police and fire chiefs, health professionals, and community groups.
But our collective efforts haven’t been enough. Until we change the culture around how opioids are prescribed and dramatically reduce the number of pills available, people will continue to die.
Since 1999, the number of prescription painkillers sold in the U.S. has nearly quad-rupled. In 2014, there were 4.6 million opioid prescriptions written in Massachusetts alone — enough for nearly every adult in this state to have a bottle of pills. Meanwhile, overdose deaths have risen by more than 300%.
We won’t solve this crisis until we cut it off at its root, by reducing the use of prescription opioid painkillers like OxyContin, Vicodin, and Percocet. Cheap heroin is not a new problem; it’s been around for decades. What is new is that four out of five heroin users report having previously used a prescription opioid. These powerful drugs are a synthetic version of opium. They’re heroin in a pill.
The opioid epidemic is the direct result of years of overprescribing painkillers to everyday people, who get hooked on an extremely addictive substance, then turn to heroin when they can no longer afford to sustain an expensive pill habit.
While heroin is certainly a problem, three times as many Americans are hooked on opioids. Pharmaceutical companies told us for years that they weren’t addictive, but we know better now. Medical studies have shown that up to a third of long-term opioid users meet criteria for addiction, and that physical dependence can happen in as few as five days.
While the vast majority of prescribers are trying to do the right thing, we must end the illegal prescribing we know is taking place. My office has formed an investigative group to identify practitioners who are illegally prescribing opioids to people who shouldn’t have them. This partnership will allow state and federal law-enforcement agencies to share information about individuals who run ‘pill mills’ or prescribe to people with a history of substance abuse.
But to combat the opioid crisis more fully, we need societal change. The Centers for Disease Control and Prevention has proposed nationwide guidelines to help medical professionals across the country understand when and how opioids should be used, particularly for chronic pain. The pharmaceutical lobby and some sectors of the medical community have pushed back against these guidelines, calling them too restrictive. But here’s my view: thousands are dying, and something desperately has to change. Thirty-six other state attorneys general share that view and recently wrote a similar letter in support of the guidelines.
There’s another simple solution that can be put in place immediately. We need prescribers to check the state’s prescription-monitoring program every time they write a prescription for highly addictive drugs. The program can flag when a patient is receiving multiple prescriptions, doctor shopping, or showing signs of addiction. Right now, only one in four doctors checks. Gov. Baker has proposed that all prescribers check the prescription-monitoring program every time they write one of these prescriptions. When New York State passed a similar mandate in 2012, it saw a 75% drop in doctor shopping. This modest step can save lives and is time well-spent.
Those who continue to push back against safeguards like these should spend time with any of the thousands of parents across this state who have lost a child to opiate addiction. All too often, theirs are stories of high-school athletes and honor-roll students who became hooked on opioids after an injury. Others began by experimenting at a party — but if our medicine cabinets weren’t full of prescription painkillers, our kids wouldn’t have such easy access to them.
We can’t hear those stories any longer and fail to act. Other countries have figured out how to manage pain without releasing a flood of dangerous drugs into their communities. We need to do the same. If we don’t, the deaths will continue.
Maura Healey is the attorney general of Massachusetts.