Bold Steps Needed to Curb Opioid Abuse
By DENNIS M. DIMITRI, M.D.
An epidemic of opioid use and the associated overdose deaths has been slowly building across the nation and Massachusetts for the last decade, and has now reached a crisis point. It is affecting nearly every city and town in the Commonwealth. In some communities, the crisis is unprecedented.
State officials estimate that more than 1,000 Massachusetts residents died of opioid overdoses last year — 33% percent more than in 2012, and nearly three times more than in 2000. A Harvard School of Public Health survey found that nearly four in 10 state residents personally know someone who has abused prescription pain medications.
While the total numbers may be startling, we should also remember that each individual overdose death has a human face. Each tragedy has changed a family forever. It has to stop, and the time for action is now. Physicians must step forward immediately to do everything we can to help bring this devastating problem under control. How can we do this? It starts with education.
According to the Centers for Disease Control and Prevention, more than 80% of people who misuse prescription pain medications are using drugs prescribed to someone else. These drugs are most often obtained from a friend or relative — for free, purchased, or stolen. This tells me that there are too many doses of opioid medications in circulation. By limiting this supply and ensuring that opioids are available only to patients who truly need them, we can make a big impact on the Commonwealth’s opioid crisis.
That is why the Mass. Medical Society is launching a comprehensive campaign to educate prescribers and the public about the safe and responsible prescribing and handling of these medications. The campaign has three components: guidelines to help physicians make the right decisions for their patients, free education resources for prescribers to help inform their judgments, and storage and disposal information for patients and their families.
• Prescribing guidelines. The guidelines not designed to micromanage care, but to provide guidance and information based on evidence that will improve the care of patients and lessen the risks associated with opioid prescribing. At the same time, we recognize that each patient is different, and, in all cases, a prescriber’s sound clinical judgment is important. However, we also believe that several principles should govern the exercise of this clinical judgment.
First, physicians and patients should discuss family and personal histories of substance-abuse disorders and behavioral-health concerns, before any prescription is written. Second, patients and physicians are encouraged to mutually develop agreements that outline the expectations and goals of the treatment, along with the conditions for continuing opioid therapy for chronic pain after initial treatment. Finally, there are exceptions for hospitalized patients, those in hospice and palliative care, and for those being treated for cancer. These patients have special circumstances that do not yield readily to hard and fast rules. Their care must be based upon long-held medical principles of relief of suffering.
We’re offering these guidelines with the hope that they will be adopted by physician practices throughout the state. We are also sharing them with the state Board of Registration in Medicine, in the event that the board will consider incorporating them into its prescribing guidelines for physicians.
• Prescriber education. The Mass. Medical Society has long been a leader in providing continuing medical education to physicians and other clinicians about pain management. We will now make these pain-management courses available to all prescribers, for free, until further notice. This includes not only our current suite of courses, but those currently in the pipeline that are due to be released in the coming weeks and months.
• Public education. An effective first step to reduce non-medical opioid use is through education. Therefore, in an effort to curb the supply of prescription opioids in the community, we are partnering with the Partnership for Drug Free Kids and its Medicine Abuse Project to broadly disseminate information about the safe storage and proper disposal of opioid medications.
Most people are probably unaware that their medicine cabinets are attractive targets for those who would misuse opioids, and that they could be an unwitting supplier. Our education program will provide guidance on how to safely store and secure medications, and how to get rid of them when they are no longer needed.
There is no more important public health issue today than the opioid epidemic. It is devastating communities, families, men, women, rich, poor, and, most tragically, children and adolescents. It has to stop — and we are ready to do our part.
Dr. Dennis M. Dimitri is president of the Mass. Medical Society.