I recently reported on the president's declaration of the America's opioid crisis as an official public health emergency. At the time, I noted that the president was awaiting final recommendations from his commission before deciding on a plan of action for combating this growing epidemic. With input from researchers, medical professionals, recovery experts and families directly affected by opioid addiction, the commission has delivered its recommendations.
Among the primary recommendations is a call for a federally funded media campaign to educate the public on the dangers of opioids. The goal of this campaign is to not only get people into treatment, but to remove the stigma attached to addiction; to call for compassion rather than to shun and stigmatize the addicted; to educate the public that addiction is a disease, not a moral failure.
In addition, the commission requests that the administration require states and doctors to use a national prescription drug-monitoring database to track patients with potential abuse problems as well as doctors who are prescribing large amounts of opioids. Another suggestion is to give the Labor Department authority to impose penalties on insurance companies that deny coverage for those in drug treatment programs.
What the recommendations are short on is a request to free up needed new funds to address the crisis or calling for an assessment of accountability for the mess we now are in.
The current epidemic of overdoses was responsible for the death of more than 64,000 Americans within a 12 months period ending last January. An estimated 500,000 people have died from drug overdoses in this country since 2000. Annually, the number of deaths now surpasses the number of people that die in car accidents or from gun injuries. Roughly, 1,000 people a day are treated in emergency departments around the country for opioid dependence-related problems. In 2011, there were enough opioids prescribed in this country for every single American to receive a month's worth of a commonly prescribed painkiller.
As recently pointed out by Reuters News, the current practice of doling out pain pills has had an especially devastating effect on our wounded warriors. Veterans are twice as likely as non-veterans to die from accidental overdoses of highly addictive painkillers.
One legislative effort to address the issue remains stalled in Congress. Sponsored by Senator John McCain, the Veterans Overmedication Prevention Act calls for finding ways to help Veterans Administration doctors rely less on opioids in treating chronic pain. The bill may never see the light of day.
How did we get to such a sorry state?
Michael Barnett is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health. He is also a primary care physician at Brigham and Women's Hospital. In a commentary recently posted on Harvard News, he describes the growing practice of prescribing opioids as one of the largest shifts in the culture of medicine to occur over the past three decades. The volume of opioids prescribed in the U.S. more than tripled between 1991 to 2011. As Dr. Barnett points out, this shift is unrelated to any significant change in disease burden or the burden of pain in the U.S. From the 1990s to the early 2000s, a parade of new formulations of opioids, including OxyContin, received approval by the Food and Drug Administration and began to be marketed to physicians as safe alternatives to treat pain. At the same time, the idea that pain was under-treated in medicine and that physicians were unnecessarily scared of opioids became a resounding marketing message. Studies are showing that even short-term use of opioids can lead to long-term addiction. Even armed with this knowledge, nearly 19 percent of people leave emergency rooms with an opioid prescription.
The concept of pain is a tricky one. There seems to be no universal consensus on what is and what is not pain. Pain does not always indicate damage. Pain is complex. What has for too long been overlooked is the fact that there are non-pharmacologic therapy options proven successful in treating pain.
For the past three decades, opioids have routinely been overprescribed for pain relief. It's almost become a reflex response. For some types of pain, non-opioid alternatives might work just as well — the Food and Drug Administration recently admitted as much.
In May, the Food and Drug Administration released proposed changes to its blueprint on educating health care providers about treating pain to include chiropractic and acupuncture. The draft guidelines now recommend that doctors get information about these alternative therapies as a possible option in helping patients avoid prescription opioids.
In a recent study published in Journal of the American Medical Association, scientists tested whether alternative painkillers could be effective in treating pain in emergency rooms. Patients were randomly assigned to receive either non-opioid painkillers, or one of three variations of opioid-based painkillers. After two hours, the doctors asked them to rate their pain on an 11-point scale. They then compared their responses. There was virtually no difference between the pain ratings among those who were given the non-opioid pain relievers and the opioid-based ones.
No one questions the fact that pharmaceuticals have greatly contributed to the health and longevity of people around the world. But you have to wonder how physicians, pharmaceutical companies and the government could let things go so far off the rails. How we have come to a regulatory and ethical environment where profits weigh so much more heavily than the health and wellbeing of people.
Write to Chuck Norris ([email protected]) with your questions about health and fitness. Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook's "Official Chuck Norris Page." He blogs at http://chucknorrisnews.blogspot.com. To find out more about Chuck Norris and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.