Promises of Pain-free Days

Dear Leading Ladies,

The opioid epidemic in our country, and around the globe, continues. Despite recognition of the addictive properties of Oxycontin; despite the lawsuits against its manufacturer, Purdue Pharma; despite the uncovering of the unscrupulous and dishonest methods employed by sales reps to encourage doctors to write unnecessary prescriptions; despite the closing of endless “pill mills” operated by shady doctors; the epidemic rages on.

Pain free? What’s not to like?

Opioids are defined by the CDC as “substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain.” They include prescription medications such as Oxycontin and Fentanyl, as well as illegal substances such as heroin. Oxycontin is a semisynthetic opioid derived from the opium poppy plant and chemically similar to morphine. Fentanyl, when used other than under medical supervision and for “recreational use,” is sometimes mixed with cocaine, heroin, MDMA, or methamphetamine. Fentanyl is 50 to 100 times more potent than morphine, the main ingredient in OxyContin. Users build up a tolerance to dosages, requiring more and more in time to achieve either pain reduction or the desired high.

AdobeStock/Kimberly Boyles

Although these prescription drugs can be very effective in treating pain, the risk of addiction is high. According to the CDC, “as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction.” Furthermore, more than “70% of drug overdose deaths in 2019 involved an opioid.” That’s 50,000 people.

The blame game

So, we could argue about who or what’s to blame for this crisis. And there are plenty of bad players to point fingers at. There is the Sackler family, which promoted OxyContin, ignoring all they knew about its potential for addiction. There are the salespeople who wittingly or unwittingly fought to meet their quotas by hawking drugs with false promises. There are the doctors who enjoyed dinners and honorariums and trips to nice places in exchange for endorsing prescription drugs. There are even FDA personnel who abused their positions, approving applications without adequate oversight in order to advance their careers in the private sector and line their pockets.

What can be done?

But what can be done to change the system that allowed this crisis to occur?

An article in a Canadian medical journal (“Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy”) outlines some ideas. The authors, Sheena Taha, Bridget Maloney-Hall, and Jane Buxton, suggest that doctors need more training about pain management alternatives in medical school. This could lead to fewer prescriptions for opioids. Better monitoring of patients prescribed opioids is another measure that could send patients home from acute care hospitals weaned from drugs and with pain under control. As for those already addicted, the authors point to the need for the decriminalization of drug use, better treatment options, more availability of overdose reversal drugs.

In 2019, noting that there was more than one opioid prescription per person each year in the United States, the Brookings Institution also outlined several actions to tackle the opioid crisis. They note that 49 states have instituted Prescription Drug Monitoring Programs (PDMPs) that allow doctors to see if a patient has received a prescription from another doctor. Brookings suggests doctors be required to check these databases. The federal government issued guidelines with limits for prescribing opioids; Brookings suggests states adhere to these. In addition, Brookings calls for a crackdown on “pill mills,” more education for providers, and increased insurance coverage for alternative pain management treatments.

As with the Canadian writers, Brookings suggests better and more available treatment for those already addicted, with expanded Medicaid coverage to pay for medication-assisted treatment (MAT) and other programs, whether people are insured or not, and for those incarcerated. Economically depressed states should be targeted.

Finally, Brookings suggests increased availability of Naloxone, the drug that can reverse an overdose; safe needle exchange centers; and targeted treatment for those just released from prison who are forty times more likely to overdose from opioids than the general public.

What can we do?

The opioid crisis is a many-faceted and multi-colored problem. It affects all communities, all strata of society. According to the Kaiser Family Foundation, in 2017 Blacks accounted for 12 percent of all opioid-related fatal overdose victims (about the same as the percentage of Blacks in the US), while non-Hispanic whites accounted for 78 percent of all victims. Yet different communities have different access to treatment and to medical care, with wealthier people having more options. Drug addiction and treatment should be considered a public health issue and not a private one. So, once again, we are back to the subject of equal access to quality health care.

Adding even greater urgency to the issue of drug addiction is the growing epidemic around a cheaper form of methamphetamine, which is associated with psychotic behavior and easily available on the street. The meth available now, according to a recent article in The Atlantic, is “different chemically than it was a decade ago” and is “creating a wave of severe mental illness and worsening America’s homelessness problem.”

Besides letting our senators and representatives, on the state and federal level, know that we want checks and balances on our doctors and medical facilities, let’s let them know we want quality treatment available in our urban economically desperate communities as well as our indigenous rural neighborhoods, where the need is great and opportunities limited.

We all deserve hope that our future will be better.

Stay well,

Therese
Judy
Mary
Beth
Leading Ladies Executive Team
leadingladiesvote.org
ladies@leadingladiesvote.org