The U.S. Department of Health & Human Services recently declared the country to be “in the midst of an unprecedented opioid epidemic.” Just how big of an issue is opioid addiction? More than a half a million people died from drug overdoses in the US between 2000 and 2015, according to the Centers for Disease Control and Prevention (CDC). Perhaps even more eye-opening? That 91 Americans die every day from opioid overdoses, including prescription opioids and heroin.
While the US has the highest share of opioid users in the world, other countries everywhere from Australia to Serbia, are facing opioid issues of their own. One group of professionals uniquely positioned to help reverse the trend? Physicians.
“A Critical Role”
More than half of opioid-related deaths are caused by prescription drugs, including Methadone, Oxycodone, and Hydrocodone. As a result, doctors are positioned to “play a critical role” in addressing the issue, according to a recent New York Times editorial. Research published earlier this year in The New England Journal of Medicine reveals a stark takeaway: “Increasing overuse of opioids in the United States may be driven in part by physician prescribing.”
As Dr. Michael Barnett, assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health, told Time, understanding the issue begins with the question, “What's the beginning of this transition to chronic opioid use? How does that happen?” In setting out to answer this question, Barnett’s team determined that opioid addiction depends not just on who starts taking the drugs -- research shows that patients with a history of substance abuse, such as smoking, are also more vulnerable to opioid addiction -- but also on the doctor prescribing them.
Specifically, researchers discovered even more variations in the rates at which doctors prescribe opioids than the expected when commencing the study. Concludes Time, “Doctors in the top 25 percent of prescribers prescribed an opioid for nearly 1 in 4 of these emergency department patients, while in the bottom group, physicians prescribed patients opioids only seven percent of the time. In other words, patients who saw a high prescriber were three times more likely to get an opioid prescription.”
The researchers then looked at the degree to which this difference impacted patients: Which ones showed signs of long-term use months into the future? As it turned out, those who’d seen high prescribers were 30 percent more likely to become long-term users.
There’s also a common misconception that emergency room physicians are to blame for both overprescribing and under-educating, according to Barnett, who told Time that primary care doctors and internal medicine specialists prescribe even more opioids than ER doctors. In other words: “The whole medical community has a responsibility for this.”
The research also highlights several key takeaways for doctors. For starters, adopting a cautious approach matters. Said Barnett, “There is a damaging effect of even that first initial prescription you get.”
But there is also a tremendous need for more education and guidelines about how to safely and effectively treat pain -- both with and without opioids. Barnett told Time, “I think it’s a warning shot to doctors about understanding the risks of these medications and communicating them much more clearly—both to each other during training, as well as the patients.”
However, it doesn’t end with talking to patients about proper use, but also extends to teaching patients about safely storing their medications, according to the American Medical Association (AMA) Task Force to Reduce Opioid Abuse. Data indicates that more than 70 percent of people opioid analgesic abusers obtain them from family members and friends. Because of this, the CDC recommends that doctors, “discuss risks to household members and other individuals if opioids are intentionally or unintentionally shared with others for whom they are not prescribed, including the possibility that others might experience overdose at the same or at lower dosages than prescribed for the patient.”
Experts are also advocating for doctors -- and insurers -- to open up to alternative treatments, including everything from acupuncture to physical therapy - to give patients safer, less costly options.
Even in cases where opioids are necessary, there are some things doctors can do to limit abuse, such as screening patients and writing prescriptions for shorter time frames at lower doses. They should also pay attention to state drug monitoring programs which can help them identify patients who may be seeking out multiple prescriptions from different sources.
While holding doctors to blame for the opioid epidemic may be an extreme perspective, the reality is that they can and should be accountable. Said U.S. Surgeon General Vivek Murthy in a letter urging members of the medical community to pledge to do their part to end the crisis, “Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because healthcare is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.”
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