By Ajay K. Singh, MBBS, FRCP, MBA
Tuesday, January 17, 2017
The 2014 National Survey on Drug Use and Health estimates that approximately two million Americans are addicted to prescription opioids. Over the past 20 years, prescription opioids have led to over 165,000 deaths in the US. In 2015 alone, more than 15,000 people died from overdoses involving prescription drugs.
The recently published Washington Post/Kaiser Family Foundation Survey, explored the factors that led individuals to become long-term users of prescription opioids. The report is important because it provides explanations for why long-term addiction to opoiod painkillers is so difficult to manage.
Some details about the survey…
Telephone interviews of 809 randomly selected adults age 18 years and older, or a household member, were conducted in the fall of 2016. Long-term users were defined as individuals who had taken prescription painkillers for two months or more at some time during the prior two years. They excluded individuals who had taken painkillers for either cancer or terminal illness. About one-third were telephone surveys of landlines and two-thirds of cell phones.
The report revealed that:
- Most chronic users were started on opioids via a prescription from a doctor.
- Indications for opioid drugs included, chronic pain (44%), pain post-surgery (25%) or pain following an accident or injury (25%). Only 3% stated that they started opioids for recreational reasons, but subsequently about 1 in 5 said they were also using painkillers “for fun or to get high.”
- Most chronic users had debilitating disability or chronic disease (70%).
- About 57% of chronic users stated that opioids made their quality of life better. 92% indicated that the major reason for taking the painkillers was to reduce physical pain.
- Doctors discussed the possibility of addiction or dependence only 65% of the time when users began painkillers.
- Doctors discussed “other ways to manage pain besides these painkillers” only 62% of the time.
- Most of those surveyed blamed themselves and the doctors who prescribed the drugs, but also stated that the drug manufacturers and the government should take blame.
- The majority of users (≈80%) recommended greater education directed at doctors and medical students about treating pain. They also recommended more research and greater access to addiction treatment programs.
[HMS Global Academy will launch a free CME opioid course in the spring.]
So what’s the bottom-line?
First, it will be hard to get individuals off opioid painkillers if they perceive that they need them. As Emily Guskin writes in the Washington Post, “At the center of the nation’s opioid crisis is a simple fact: Large numbers of Americans experience serious pain, and the vast majority of those who have used strong painkillers for a long period say they work.”
Second, doctors need to do a better job of discussing with patients the risks of addiction and alternatives to opioids. As a December 16 editorial in the Washington Post states, “a key condition…is for doctors to become much more careful in the way they distribute these powerful pills, which are still widely prescribed for noncancer pain, notwithstanding what is now a mountain of evidence, accumulating for years, that the drugs are far more addictive than manufacturers once led physicians and patients to believe.”
The Post editorial concludes: “If progress is to be made … American medicine must redouble its commitment to sound prescribing practices.” Clearly, there is a view at least among the media that education for doctors and other clinicians is still needed about whom to treat for pain and for how long.
And, third, better and more effective painkillers are necessary. In a December 22, 2016 article in ScienceNews, Bethany Brookshire reviews the hunt for a safer opioid painkiller, and in a January 13, 2017 Smithsonian magazine article, John Kelvey discusses the clinical development of the only alternative to morphine, Oliceridine. A powerful rapidly acting and nonaddictive painkiller is desperately needed, and it seems like a candidate is on the horizon.
The Opioid Use Disorder Education Program
The Opioid Use Disorder Education Program (OUDEP) is now available from HMS Global Academy. OUDEP is comprised of 3 free online CE/CME courses produced by Harvard Medical School (HMS) with scientific contributions from The National Institute on Drug Abuse (NIDA). These courses are intended for nurses, nurse practitioners, physician assistants, physicians, and other health care providers collaborating to treat patients with substance use disorders.
Dr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.