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Author: Aaron C. Tyagi, MD
Chair, RSA Social Media Committee
Originally Published: Common Sense January/February 2018
We have seen the rate of overdose mortality in general and mortality of overdoses related to opioids continue to rise.[1,2] As a society, we were slow to recognize this problem, for a number of reasons. Now it is incumbent upon us to respond appropriately and in a timely manner. But our opportunity in which to do that in is quickly shrinking. It seems the executive branch and President Trump have recognized this.[3] But let’s actually take closer look at what we’ve done and what we’re doing currently.
Drug overdose and opioid overdose continues to be a problem in the United States. According to a 2016 report by the CDC, of the 47,055 deaths from drug overdoses that occurred in 2014, 28,647 (60.9%) involved an opioid. The following year (2015), the number of deaths from overdoses rose to 52,404 with 33,091 (63.1%) from opioids.[4] We are constantly exposed to this in the ED. We (the ED and our EMS colleagues in the field) are the frontlines when these patients come in dead or near-dead and need to be resuscitated. We know first-hand the potentially devastating effects of these medications.
It’s not hard to see why we were so blind to the problem this was going to pose and currently is causing. When opioids first came on the market, they were advertised as a quick-fix for pain, with a minimal side-effect profile. Profits for pharmaceutical companies sky-rocketed as physicians thought they had a great solution to pain that was “safe” and non-habit forming. This quickly proved to be untrue. However, we were slow to recognize this.
Now we are in the midst of an epidemic of our own making. It is on us to find solutions to this problem.
The first step is recognizing and acknowledging that the opioid addiction crisis is something that needs treatment. In Washington, things such as the Comprehensive Addiction and Recovery Act (CARA) 2016 (P.L. 114-198), Addiction Treatment Access Improvement Act of 2017 (H.R. 3692), and Stem the Tide of Overdose Prevalence from Opiate Drugs (STOP OD) Act of 2017 (H.R 664) have been or are on the table as broad-stroke solutions. It is this process that has allowed more and more states to prescribe naloxone. Some states now have it available over-the-counter at local Walgreens or CVS stores.[5]
Additionally, approaching addiction from a multi-faceted view has some momentum. A recent trial was published in JAMA Internal Medicine detailing collaborative care vs. usual care and showed a collaborative approach was associated with increased access to treatment and abstinence from alcohol and opioids at six months.[6]
While we are moving in the right direction, we still have ways to go. We have done better by recognizing pain and addiction as a problem that requires a multi-disciplinary approach to treatment. But still more advocacy needs to be done by us a physicians, both locally and nationally. For example, the current administrations recent attempts to repeal and replace the Affordable Care Act (ACA) would have resulted in significant cuts to the Centers for Medicaid and Medicare Services (CMS). This is a key way by which most recovery centers are funded.
By getting more involved with our local and national policy-makers, we as physicians have a powerful voice in making sure that this iatrogenic disease gets addressed and hopefully cured correctly.
References:
1. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167:293–301. doi: 10.7326/M17-0865
2. Moy et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014. MMWR Surveill Summ. 2017 Jan 13;66(1):1-8. doi: 10.15585/mmwr.ss6601a1.
3. http://www.politico.com/story/2017/10/20/trump-opioid-plan-blindsides-advisers-243974?ct=t(202_For_You_Oct_4_2017)
4. Rudd, RA, Seth, P, David F, Scholl L. Increased in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015. MMWR Mrob Mortal Wkly Rep 2016;65:1445-1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1.
5. https://evolutionstreatment.com/states-offer-naloxone-over-the-counter/
6. Watkins KE, Ober AJ, Lamp K, Lind M, Setodji C, Osilla KC, Hunter SB, McCullough CM, Becker K, Iyiewuare PO, Diamant A, Heinzerling K, Pincus HA. Collaborative Care for Opioid and Alcohol Use Disorders in Primary CareThe SUMMIT Randomized Clinical Trial. JAMA Intern Med. 2017;177(10):1480–1488. doi:10.1001/jamainternmed.2017.3947