Working to Lower Addiction to Prescription Painkillers
Opioid narcotics – prescription painkillers – are the most frequently prescribed medications in the country today. The amount of pills being recommended to patients by their doctor is staggering having increased four times over the number of prescriptions just ten years ago.
Doctors are recommending these drugs to their patients with chronic pain despite the fact that their effectiveness with long-term use is questionable to say the least. On the contrary, studies are emerging which show that opioid use can be definitively linked to problems with hormone production, sleep apnea and worsening unsteadiness among elderly patients. The number of cases of fatal opioid overdoses is also rising alarmingly. There were almost 15,000 fatal overdoses involving opioids in 2008 – the most recent year for which statistics are available.
Many doctors are prescribing these powerful drugs in a responsible manner. Nonetheless, long-term use can create an emotional dependency similar to that witnessed in addiction. Concerned over the number of prescriptions and the very real potential for addiction, lawmakers in some states are working to impose tighter regulations when it comes to prescribing. One state now requires a doctor who has been treating a patient with opioids to refer that patient to a pain specialist if his/her treatment does not appear to be resolving the problem. In response to this kind of legislation some doctors are simply refusing to treat patients who come to them with chronic pain.
While there needs to be consideration given to patients who are living with serious ongoing pain (e.g. arthritis, degenerative joint disease), it bears mentioning that using opioids to treat patients with chronic pain is a relatively recent practice. As few as 15 years ago these drugs were used almost exclusively as palliatives for cancer patients and those facing the end of life. More astonishing still given the current climate of opioid abuse, makers of these drugs are currently creating newer and stronger versions of them. While the surge in prescribing has made these drugs enormously profitable, the obvious question remains as to whether or not it is responsible to devise more powerful formulations of them.
Close examination of many hundreds of 2006 workmen’s compensation claim forms found that 32 workers treated for injury with opioids actually died of drug overdose. Those same claims further revealed that the average strength of daily dosages rose by greater than 50 percent. While some health care professionals claim that such increases are appropriate under careful doctor monitoring, the facts reveal that the doctors often increase patient doses without the necessary level of attention. The irony is that initial investigation points to high opioid doses as actually making patients more sensitive to pain.
The hurdles faced by any move to lower opioid prescribing are significant. Doctors must be willing to help patients embrace alternative and sometimes non-drug therapies and insurance companies must be ready to pay for them. Pharmaceutical companies will not likely give up a lucrative line of medications easily, but the evidence is mounting that lowering opioid prescribing will soon become the true measure of evidence-based healthcare.