At the heart of our opioid cri­sis

Maryland Independent - - Community Forum - Reprinted from The Dal­las Morn­ing News.

Pres­i­dent Don­ald Trump held a “lis­ten­ing ses­sion” about opi­oids and drug abuse at the White House last month. The gather­ing in­cluded former ad­dicts, par­ents of chil­dren who had over­dosed, top fed­eral of­fi­cials and oth­ers. Trump vowed to make drug treat­ment more widely avail­able — a worth­while goal with bi­par­ti­san ap­peal. He also spoke of strength­en­ing law en­force­ment and dis­man­tling drug car­tels.

But there is a cheaper, low-risk tac­tic for curb­ing some opioid mis­use that was ne­glected: chang­ing doc­tors’ pre­scrib­ing habits and bet­ter ed­u­cat­ing pa­tients. A re­cent study found that for ev­ery 48 pa­tients who re­ceive an opioid pre­scrip­tion in the emer­gency room, one will likely be­come a longterm user. A more cau­tious ap­proach to pre­scrib­ing could save lives.

Across the United States, health care pro­fes­sion­als wrote 249 mil­lion pre­scrip­tions for opioid pain medicines in 2013. In 2015, about 22,000 Amer­i­cans died af­ter over­dos­ing on some form of opioid drug, le­gal or il­licit, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Of those deaths, 15,000 were at­trib­uted to pre­scrip­tion opioid over­doses.

There is no med­i­cal ex­pla­na­tion for the rise in opioid use. Sales of pre­scrip­tion opi­oids nearly quadru­pled from 1999 to 2014, even though Amer­i­cans don’t report hav­ing more pain now. Pre­scrib­ing rates var y widely among states, even though health con­di­tions don’t. Even among doc­tors work­ing in the same emer­gency room, some pre­scribe opi­oids much more fre­quently than oth­ers.

The fed­eral government — along with some states and pro­fes­sional as­so­ci­a­tions — has pro­duced ex­ten­sive pre­scrib­ing guide­lines. Opioid med­i­ca­tions are not the pre­ferred op­tion for man­ag­ing chronic pain; doc­tors and pa­tients should try other ap­proaches first and care­fully weigh risks be­fore start­ing pre­scrip­tion opi­oids. For acute pain, such as af­ter surgery, doc­tors should pre­scribe the low­est pos­si­ble dose of opioid for the short­est du­ra­tion. Pre­scribers must be es­pe­cially care­ful with older adults be­cause opioid painkillers can put se­niors at higher risks of falls and frac­tures.

Phar­ma­cists, pa­tients and law­mak­ers have an im­por­tant role.

And the pub­lic can help, too. How do most peo­ple who mis­use pre­scrip­tion pain med­i­ca­tions get them? One large study showed that about half ob­tained them free from friends or rel­a­tives. So, if you have pain pills left over from surger y or den­tal work, take them to a drug take-back event or to a drop­box at a par­tic­i­pat­ing lo­cal po­lice agency or phar­macy. Na­tional Pre­scrip­tion Drug Take Back Day is Satur­day, April 29. Look for dis­posal lo­ca­tions in the com­ing days in this paper.

If you don’t have ac­cess to a takeback event or a drop­box, then flush pre­scrip­tion opi­oids — such as those con­tain­ing oxy­codone, fen­tanyl, mor­phine, buprenor­phine, hy­drocodone, oxy­mor­phone — down the toi­let. Re­ally. These med­i­ca­tions are so dan­ger­ous when mis­used that the FDA rec­om­mends flush­ing them down the toi­let if you can’t find an official drug take-back event. For a full list with names of med­i­ca­tions that the FDA rec­om­mends flush­ing if an­other dis­posal method is not avail­able, go on­line to https://www.fda.gov/drugs/re­sources­foryou/con­sumers/buyin­gus­ingmedicine safely/en­sur­ingsafeuse­ofmedicine/safedis­pos­a­lofmedicines/ucm186187.htm#Flush_List.

Prop­erly dis­pos­ing of pre­scrip­tion opi­oids will keep every­body in your home — you and your friends, rel­a­tives, kids and pets — safe.

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