September 27, 2016
Area(s) of Interest: Drug Prescribing/Dispensing Public Health
The turbulent nature of this year’s election has generated plenty of debate across political party lines, but there’s one thing Democrats and Republicans both seem to agree on: prescription opioid misuse is a major problem in the U.S., and more must be done to fight it.
Forty-six percent of Democrats and 44 percent of Republicans know someone who has recently abused prescription painkillers, according to a recent poll by Stat and the Harvard T.H. Chan School of Public Health. Nationwide, at least half of all opioid overdose deaths involve prescription drug misuse, according to the Centers for Disease Control and Prevention. Nearly two million Americans “abused or were dependent on prescription opioids” in 2014, and more than 1,000 people are treated daily in our nation’s emergency rooms for misusing their opioid prescriptions.
These figures leave little room for doubt, as do the endless first-hand experiences of physicians, like myself, who witness individuals trying to obtain painkillers for illegitimate reasons. Of course, many of the patients that physicians see are in genuine need of pain relieving prescriptions. Chronic pain — or pain that lingers for weeks, months or even years — impacts about 100 million adults in America, according to the Institute of Medicine. Opioid medications have been an important part of managing chronic pain and there is a proper place for their use. With roughly one-third of the country affected by chronic pain, it’s easy to see the need for relief.
What the country has learned, however, is that problem of pain is more complex than simply providing relief. Opioid prescriptions, even if given for the right reasons, can be dangerous and deadly if used improperly. And they must be prescribed safely. Hydrocodone (Vicodin), Oxycodone (OxyContin) and Methadone have proven to be particularly perilous when misused and top the CDC’s most common drugs associated with opioid overdose deaths.
We’ve also found that abuse stretches beyond those who have been examined by a physician and received a legitimate pain prescription. An analysis of data from a 2009 and 2010 study revealed that the overwhelming majority of Americans (71 percent) who used painkillers without a prescription obtained them from family members or friends. Recent evidence also indicates that illicit manufacturing of synthetic opioids (e.g., fentanyl) has been linked to increases in overdose and abuse.
Does this mean doctors are exempt from helping curb the problem of opioid misuse? Not at all. California’s physicians are at the forefront of these efforts and working with other stakeholders to ensure opioid medications are prescribed and used responsibly.
The California Medical Association, which advocates on behalf of the state’s physicians with more than 41,000 members, has created a resource center
, released white papers in 2013 and 2014 outlining safe and effective pain management, as well as recommendations on how to reduce medication misuse. It also collaborated with the Medical Board of California to develop safe prescribing guidelines in 2014, hosted educational webinars for members, supported emergency room guidelines, backed National Drug Take Back Day efforts and encouraged increased access to opioid use disorder treatments. I’ve been honored to represent CMA on the American Medical Association’s Task Force to Reduce Opioid Abuse, which is making a national impact on this pressing problem.
Similar efforts are being carried out at the local level, and many of California’s county medical societies
have launched safe prescribing programs or published local provider and patient resources to obtain naloxone, an opioid overdose antidote.
These endeavors have helped produce some positive results in our state. California reduced its supply of opioid prescriptions by 2.3 million since 2013, which ties the state for the lowest number of painkiller prescriptions per capita in 2015. Our age-adjusted drug overdose death rate also ranks in the lower range at 11.1 per 100,000, below the national average of 14.7 per 100,000, and California is one of 15 other states that did not see its opioid overdose rate increase in 2014.
Despite these advancements, there’s more that must be done. We need to increase access to medication-assisted treatment for opioid use disorder, as well as more physician training to provide this treatment. Medication-assisted treatment has proven safe and successful when used appropriately, but too many patients lack access to it.
We also need to be sure that multimodal and multidisciplinary pain treatment approaches are available to patients without high costs and administrative barriers. Multidisciplinary pain treatment emphasizes a range of strategies aimed at maximizing pain reduction, improving quality of life and increasing function. However, too many patients are unable to access this treatment because their insurance company would not cover it or it is too expensive.
Unfortunately, some treatments are excluded as being “experimental” even though they have a long clinical track record of effectiveness. This denial of comprehensive treatment has in part resulted in physicians being limited to medication management for the treatment of chronic pain in many patients that have failed nonmedication management techniques.
The problem is too broad and complex to solve overnight, and no single group, law, policy change or initiative can solve it alone. But make no mistake: physicians are dedicated to reducing this crisis while ensuring patients get the relief they need. And we’ll continue working with other health advocates to implement comprehensive and balanced solutions.
We believe that each patient is unique, and the best medicine is practiced one patient at a time. We practice and promote the science and art of medicine while understanding that the relationship between a patient and their physician is the bedrock by which we will successfully tackle this problem.
Dr. Snook has been dedicated to the growing field of pain medicine since 1992. He’s the President and Founder of Metropolitan Pain Management Consultants (MPMC) in Sacramento and has successfully treated thousands of patients suffering from pain. Dr. Snook is Board Certified in Internal Medicine, Anesthesiology with Subspecialty Certification in Pain Medicine, is Board Certified in Pain Medicine, and is a Diplomat of the American Board of Addiction Medicine. A member of the California Medical Association since 1985, he currently serves as Vice Speaker.