Doctors can ease abuse of opioids
Last week, thousands of my physician colleagues and I received a letter from the U.S. Surgeon General, Dr. Vivek Murthy. He asked us to change our behavior in prescribing pain medicines.
Around the same time, I was seeing a middle-aged man who had been admitted to the hospital for the fifth time in the same number of months for “pain.”
A week earlier another patient burst out at the nurse, “I am not taking my antibiotics until I get my pain medicine.” His skin infection did not warrant narcotic pain medicine.
And in yet another case, the nurse found a patient’s bedside drawer full of pain medications. “The drugs have a good street price,” the patient told me.
Undeniably, our nation is in the midst of an opioid epidemic, and Tennessee is at its epicenter.
Each year, the number of prescriptions written for pain pills in America is enough for each adult to have their own bottle. Tennessee is ranked among the top three states in the nation with the highest painkiller prescription rate, along with Alabama and West Virginia. And the prescription rate of one drug, oxymorphone, is 22 times higher in Tennessee than in Minnesota.
Where are people who abuse prescription pain medicine getting them? A 2011 national survey found that 55 percent receive them free from family or friends and 16 percent stole or bought them from family and friends. Only a small number, 17 percent, were prescription medicines. But that is likely higher in our state. And even 17 percent amounts to a lot of addictive pain pills.
Doctors have many options to treat pain: nonopioid and nonaddictive options include Tylenol, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS) like Aleve. There are also non-pharmaceutical options, such as massage, biofeedback, and acupuncture. In contrast, opioids are powerful and addictive. Common opioids include hydrocodone, oxycodone, codeine, morphine, as well as heroin.
“The addiction began insidiously,” one friend told me about her husband. He began by taking a Percocet for back pain. Over the years, he visited emergency room after emergency room and kept changing doctors in a quest to keep a steady supply of opioids. Eventually he overdosed and nearly died. This is often the case when a onetime prescription creates such a strong urge that patients seek or steal pain medicines, demand that their doctor prescribe medicine or buy it on the street.
The outcome is lethal. In 2014, 1,263 people died in Tennessee from overdose (the majority of them from opioids) which is more deaths than roadway vehicular accidents.
Curbing most addictions, such as smoking and alcohol, depends on changing the behavior of patients. The opioid addiction is different. It partially depends on changing the behavior of doctors who overprescribe the highly restricted, controlled pain medications.