Fighting Texas’ own opioid epidemic
As someone who has studied use and misuse of prescription opioids and other drugs for much of my career, I know drug misuse can happen to anyone. I have had friends, relatives and neighbors pulled into misuse, which includes substance-use disorders and other dangerous behaviors, such as drug combining.
And I am not alone. A recently released statewide poll found that 1 of 3 adults in Texas knows someone who has been addicted to prescription painkillers.
As a Texas native, I’m especially dismayed by a recent report showing the number of people in Texas who died from opioid overdoses climbed 4.1 percent — nearly 3,000 deaths — over just the last year.
This tragic loss of lives is unacceptable. And preventable.
Addressing the opioid drug problem in Texas and other states requires a comprehensive and aggressive approach. I applaud Texas on what it has done to date to address this problem. While strategies to increase medication-assisted treatment programs and limiting overprescribing of opioids for transient pain are worthwhile goals, too often these measures focus on the extremes of the problem, including individuals already grappling with substance-use disorders or those for whom an opioid prescription is given for transient pain.
Based on what I’ve seen, many of the individuals most at risk are those who do not yet have a substance-use disorder but could develop one. And there are those who practice other dangerous forms of drug misuse. These individuals are often victims of daily chronic pain for which longterm use of prescription opioids is the best source of relief.
The problem is that physicians may believe that they can tell without definitive evidence if a patient will misuse a prescribed therapy. Misuse includes supplementing, substituting or abstaining from taking their prescriptions. However, these assumptions are often wrong.
For example, insights from a 2018 analysis of more than 3.9 million de-identified aggregated drug monitoring tests reveal a startling truth: more than half of patients who take prescription opioids, amphetamines and other therapies show signs of misuse when tested. Forms of misuse include dangerous drug combinations with other drugs like fentanyl, a powerful opioid, and benzodiazepines, a widely used class of anti-anxiety medications. Use of illicit drugs, such as heroin, is also a growing national problem.
Several organizations, including the Centers for Disease Control and Prevention, Department of Veterans Affairs, and the American Pain Society, already recognize the value of physicians working with their patients to monitor appropriate and safe use of prescription medications including opioids. But more is needed.
Physicians who monitor prescription drug use can play an important role in identifying statewide misuse trends. Their efforts complement Prescription Drug Monitoring Programs, which are state-based databases that track prescription data to help reveal possible concerns. These programs, such as the “Texas Prescription Monitoring Program,” are necessary and useful to help curtail prescription and illicit drug misuse.
An objective, real-time snapshot of medication adherence helps patients and physicians discuss a treatment plan, prescriptions the patient may be taking, and the benefits and risks associated with pain medications. It takes guesswork out of clinical care and provides transparency between patients and physicians to ensure that patients are receiving the best and safest treatment possible.
Texas’ state leaders can make it easier for physicians to keep patients safe by adopting regulations and policies, such as the CDC Guidelines for Prescribing Opioids for Chronic Pain, that support the use of drug testing before commencing opioid therapy and, at least annually thereafter, to assess for prescribed medications, other controlled prescription drugs and illicit substances.
For many Texans, pain is a very real, daily challenge, and physicians must be allowed to consider opioids for relief when other measures won’t do. For these patients, drug monitoring can aid the delivery of appropriate care while reducing risks. If physicians do not have access to all viable means to protect these patients, it is all but certain that prescription drug misuse — and drug overdose deaths — will continue.
McClure is the director of medical affairs for Quest Diagnostics, the world’s leading provider of diagnostics information services, including in clinical drug monitoring.