What’s going on with the opioid crisis?
- The way forward
- Why I think it’s probably not going to get any better, and
- What you can do right now to help solve this problem locally
Missing the whole picture on the opioid crisis?
You’ve probably seen a few stories about the opioid crisis. I find many of them confusing because most don’t paint the whole picture of what’s going on.
And that’s a problem, because the big picture is something that you and every health care consumer should know. Especially if you even remotely know someone affected by this situation.
The opioid crisis really isn’t just a single story, but a bunch of circumstances that have created a crisis that may not be solved without a radical overhaul of how we treat pain in America.
I always try to keep these articles upbeat, but I also want to be honest and say that this overhaul probably isn’t going to happen anytime soon.
So, in the meantime, a lot of people are going to needlessly suffer. Some are even going to die. And that’s the bad news.
The good news is that by simply taking your time to read this article, you now have the potential to save a future life by sharing this information in whatever way you think is helpful.
So here’s what’s happening, broken down into six facts.
Fact 1: Opioid prescriptions are habit forming
- Opioids are a class of narcotics that can be prescribed by doctors for pain
- Opioid are powerful, and really are helpful in serious cases (think pain related to cancer treatment and intense surgical procedures for example)
- However, opioids are also habit forming – they can be addictive, and they can also be abused by persons who were previously prescribed the drug, or by persons addicted to other forms of street narcotics
I made a video about this and posted it to the Facebook page for the practice. That video is here.
Fact 2: Opioid prescriptions were intentionally pushed, and a lot of it was illegal, or at least unethical, and people died
- The writing of opioid prescriptions tripled since 1999 while pain levels did not rise
- Deaths associated with opioids more than quadrupled, and most deaths were from pills that weren’t prescribed to the person
- In some cases, this increase was due to pressure and (alleged) bribery from pharmaceutical companies to increase these prescriptions
- Pain pill mills opened, and billions of pills were moved through small towns, and most – we can assume – went out into the street
Fact 3: The marketing and abuse of OxyContin was the biggest part of this problem
- A single pharma company held the patent for Oxycontin (Purdue Pharma)
- They increased the use of the drug by marketing it as non-addictive due to its slow time release, a claim that turned out to be a lie
- They used the “non-addictive” angle to encourage doctors to prescribe the drug for less serious pain
- They pushed to increase the number of milligrams per pill, which meant that those who who were abusing the drug could get high for a lot longer, increasing the street value of OxyContin
- Purdue identified doctors who were writing the most opioid prescriptions and had a special marketing program for them, including major bonuses for pharma reps
Fact 4: A lot of opioids are prescribed for chronic spinal pain
- Anesthesiologists and pain medicine physicians prescribe the most opioids
- Surgeons and physical medicine and rehabilitation physicians are second to the above doctors
- Spinal pain and chronic pain are the most common diagnoses leading to initial opioid prescription
Fact 5: There’s a strong link between opioid prescriptions and street narcotics like heroine
- As we covered above, most opioid prescription deaths aren’t for the properly prescribed person, for a limited treatment time
- Many opioid deaths are from abuse by those who became addicted through a proper prescription, and then started abusing once their prescription was over
- Other deaths are from those addicted to other narcotics, who found it easy to get access to opioids like Oxycontin and Fentanyl
- Many other deaths are due to the cheapness and availability of heroine, which is a street available alternative for those addicted to prescription opioids
Fact 6: Increasing and then shutting down opioid access has its own problems
- Once people are addicted to opioids it becomes a lot easier to turn to street narcotics when they can no longer fill a prescription
- Limiting doctors from prescribing to those already addicted will result in more heroine use and death
- Treatment has its own problems as many of the treatment drugs are incredibly expensive, and they too can be habit forming and abused!
Putting it all together…
So, let’s see where we are with this.
- Shady companies pushed prescriptions of legal narcotics, and some doctors took money and agreed to do so
- Average Town, USA was flooded with narcotics and millions of people who would never have developed such an addiction did so (most opioid prescriptions were written for women in their 40s)
- Once the Pandora’s box of addiction is opened it’s hard to close it without creating more problems
- Shutting down access to Oxycontin and Fentanyl will not necessarily lower addiction, as some will abuse recovery drugs, or turn to heroine
If we were to go back in time to undo this process, the answer seems obvious…
Give people alternatives for the most common causes of chronic pain than prescription opioids!
You’re probably saying, “Well, DUH!” Me too. And so are plenty of other good people in government agencies.
But here’s the problem.
The chiropractors, acupuncturists, massage therapists, and cognitive therapists don’t have millions of dollars in bribes nor endowment grants to educate the next generation of surgeons and anesthesiologists or pain doctors on how what we do can prevent the over-use of opioids.
We can’t influence the Food and Drug Administration. We just don’t have the authority to tell medicine how to do what it’s going to do.
And since the pharma lobby gives many, many dollars to representatives in federal and local governments, that isn’t going to change soon either.
So, that doesn’t feel good.
But here’s something we can do…
- We can support people who have chosen not to use opioids for their concern about addiction and their side-effects
- We can understand why some people may need opioids to function, and why addiction is a powerful side effect of treating chronic pain
- We can support addiction recovery programs, especially those geared towards OxyContin, Heroine, and other narcotics
- We can continue to recommend non-pharma strategies for chronic pain, especially chiropractic care – as so many pain problems that people are throwing powerful chemicals at really have a mechanical problem behind them
- We can bring up these facts with our primary care doctors, and ask them what kind of opioid alternatives they recommend (and encourage them if they’re aware of these facts!)
- We can let people know that for most people, opioids aren’t any better at killing pain than an strong over-the-counter painkillers
Please read that again. Despite all of this, there’s almost no evidence that opioids are actually better than strong NSAIDs
At the national level, this is going to be a problem for some time. But there’s nothing stopping us from making a little dent in this problem in our local community.
Thank you for your efforts! And to the folks in the practice who have overcome a opioid addiction, I salute you!