commentary
U.S. OPIOID ABUSE: TEACHING IS FUNDAMENTAL
BY EMILIE Y. PROT, DO Abuse of prescrip- tion pain medications has become a national epidemic behind the top three most commonly abused sub- stances — alcohol, tobacco, and mari- juana — according to the U.S. Depart- ment of Health and Human Services and the U.S. Centers for Disease Con- trol and Prevention (CDC). Patients are asking: “If a physician prescribes a medication, shouldn’t it be safe?” The dangers of misusing prescrip-
tion pain medications persist. Pain medications are not only highly ad- dictive but also cause many overdose deaths. According to CDC, nearly 15,000 people die every year of over- doses involving prescription painkill- ers, especially Vicodin and OxyCon- tin. How and when did our society become a “pill-popping” nation? President Barack Obama’s 2017
budget includes $1.1 billion to combat the country’s opioid epidemic. Funds would be allocated to treatment cen- ters, physicians and health care pro- viders specialized in substance treat-
ment, and research for treatment program evaluation. In October 2015, President Obama issued a memoran- dum on prescriber training and opioid use disorder treatment to train health care professionals on appropriate opi- oid prescribing. Additionally, CDC re- leased 2016 opioid prescribing guide- lines to help doctors provide safer and more effective care, while reducing the patient’s risk of addiction and overdose. The U.S. Food and Drug Ad- ministration has developed the Opi- oids Action Plan, which strengthens the review and approval of opioids and expands access to abuse-deter- rent formulations and label changes. The undesirable effects of toler-
ance and abuse followed the introduc- tion of opioids in the 16th century. In the United States, 24.6 million people aged 12 or older (9.4 percent of the population) live with substance de- pendence or abuse, according to the American College of Preventive Medi- cine. Of these, 1.9 million Americans live with prescription opioid abuse or
dependence. Health care profession- als prescribing pain medications must balance effectively and aggressively treating pain with the risk of misuse and abuse. Overtreatment of pain has harmed the population, with in- creased hospitalization for overdoses, polypharmacy (the use of four or more medications by a patient who is gener- ally older than 65) in nursing homes, and increased deaths. On the other hand, the Universal
Declaration of Human Rights states every human being has a right to “a standard of living adequate for health and well-being.” Treatment for pain and suffering should not be reserved for the most privileged, but should be a right of access to all. By not treating pain adequately, pa-
tients suffer not only from physiologi- cal and psychological effects but also from socioeconomic consequences. The Institute of Medicine estimates the total loss of productivity second- ary to pain at around $316.5 billion for 2010 in the United States. However, the biggest loss was not due to missed work (about $12 billion) but rather due to “reduced effectiveness” in the workplace (about $61 billion), accord- ing to a 2015 article in the Journal of the American Medical Association. Treating pain inadequately is not only medical malpractice but also poses a great economic burden to our society.
The dangers of misusing prescription pain medications persist.
September 2016 TEXAS MEDICINE 11
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