State Gets Serious About Opiate Abuse
By RICHARD PIETERS, M.D., BARBARA HERBERT, M.D., and DANIEL ALFORD, M.D.
Prescription drug abuse is now one of the toughest problems communities face, and officials at local, state, and federal levels are all wrestling with what to do about it. Multiple actions have been taken, including new laws and regulations, monitoring programs, and restrictions on prescribing, with varying results.
The Commonwealth’s new governor and attorney general, Charlie Baker and Maura Healey, have made opiate abuse one of their top priorities. That’s good news, because we are losing hundreds of lives to prescription and opiate abuse.
While drugs like heroin remain a prime cause of overdoses, 52% of the 44,000 drug-overdose deaths in 2013 were related to pharmaceuticals. And of those, 71% involved prescription pain medicines — mostly by people using drugs prescribed to someone else.
As the Institute of Medicine (IOM) has noted, pain is a significant public health problem. Some 100 million adults have chronic pain alone — more than those with diabetes, heart disease, and cancer combined. Whether chronic (constant and long-lasting), acute (of shorter duration), or cancer-related, pain is one of the most frequent reasons for physician visits and taking medication, which often helps with the acute pain of trauma, injury, or surgery.
Healthcare providers write a huge amount of prescriptions for pain medicines — 259 million in 2012 alone. Yet, with some 12 million Americans using prescription medications for non-medical reasons and with more than three out of four people who misuse prescription pain medicines using drugs prescribed to someone else, the reasons for abuse go beyond the number of prescriptions issued.
Physicians and patients together can work together to help reduce the abuse. Here’s how.
Physicians believe patients who experience pain should be able to get relief and understand that appropriately treating pain helps patients heal. Medications carry risk, however, and with opioids, one of the risks is addiction. Physicians must balance the risks and benefits of opioids — while exploring other kinds of treatment in open communication with patients.
Medicines like opioids, taken exactly as prescribed under a physician’s supervision, are excellent therapies for certain kinds of pain, but they may not be appropriate for all people.
Patients must clearly communicate expectations to their physicians. They understandably want immediate relief from pain, but taking more pills than the prescription calls for and dismissing the vital instruction of ‘take only as directed’ may risk harm and make the medicine less effective.
Insurers, who are reluctant to pay for other treatment options, such as physical therapy, acupuncture, and cognitive behavioral treatments, should begin to do so, giving physicians and patients other options besides pills.
Physicians must partner with their patients to figure out what the best treatment is, when opioids are best, and, when they’re not, what the best approach is for treatment. In many cases, the best approach may be one combining opioids with other medicines and additional methods like those named above.
Patients should be candid about their level of pain and tell their doctors what other medicines or substances (such as alcohol or marijuana) are being taken. Mixing substances is dangerous and can be lethal.
Above all, patients should be aware of the National Institute of Drug Abuse’s three elements of prescription abuse: (1) taking someone’s else’s medication; (2) taking medicine in a higher dosage or another manner than prescribed; and (3) taking medications for purposes other than prescribed. Patients have the power to act on all three.
Patients can stop the diversion of medications with responsible storage and disposal. Leaving prescriptions in medicine cabinets is a bad idea; it’s the primary way people who aren’t prescribed medicines get them. Medicines should be stored securely, preferably in lock boxes, and unused medicines should go to ‘take-back’ programs within communities.
Beyond prevention, adding more substance-abuse treatment programs to help with addiction and increasing the availability of naloxone, a prescription drug that prevents death from overdose, are steps that will save lives.
Dr. Richard Pieters is president of the Massachusetts Medical Society. Dr. Daniel Alford is director of the Clinical Addiction Research and Education Unit at Boston Medical Center. Dr. Barbara Herbert is medical director of Addiction Service at Commonwealth Care.