The Face of the Opioid Crisis

January 24, 2018

The solution to solving the opioid crisis is much more complicated than simply adding new therapies. It needs a multi-leveled approach.

Looking at me through haunted eyes, the patient told me that she wanted to come clean and didn't want to die. She predicted that she would be dead by the end of the year if she didn't get help. Her addiction started with opioid abuse and evolved into IV heroin when it was discovered that was much cheaper. Her friends all suffered a similar addiction so there was no help there. She no longer had any dreams or aspirations for the future. Her life's goal was getting the next fix, through whatever legal or illegal means possible.

However, her desire to get help and my wanting to help her was not such an easy fix. Apparently, she had the wrong insurance and rehab facilities would not accept it. Hours of phone calls to find her a rehab facility to get the help she needed turned into days and then weeks. Finally, a place was found, far from where she lived and had a three-month wait list until she could be seen. While we did schedule her at that facility, I was left hoping that she didn't change her mind or die of an overdose in the meanwhile, like the high school boy from our town who was dropped outside the ER when he was found not breathing by his friends. It was determined he died of a heroin overdose, the month before he was supposed to start college.

They are far from alone as casualties of this epidemic.  In October 2017, President Donald Trump announced that the opioid epidemic is a public health emergency.  Earlier the same week, the Food and Drug Administration (FDA) declared that since 2001, prescription drugs (largely opioids) have been the greatest cause of overdose deaths. In fact, over the past six years, there have been more deaths from overdoses than guns, cars, suicides, and murder.

In 2017, on average, more than 90 Americans die every day due to overdoses involving opioids. Of all patients who receive a prescription for opioid medication for chronic pain, approximately 21-29 percent will misuse them. Furthermore, about 8-12 percent will develop an opioid use disorder. Many experts conclude that prescription abuse can be a gateway for heroin use. It has been found that, 4-6 percent of those who abuse prescription opioids will move one to using heroin. Approximately 80 percent of those using heroin first misused prescription opioids.

While the nation is recognizing the crisis, few are stepping up to help these patients. Calling out a public health emergency without dedicating federal funds to address it does not help, except maybe in winning political supporters. People are dying while our leaders ignore taking any actual action to stop it.           

Most people who pontificate about the opioid crisis see a nameless, faceless statistic. I see the faces of patients, of parents who have lost children and children who have lost parents in this epidemic. I see the fall-out, of families destroyed, and those left mourning. This addiction is not limited to any socioeconomic status or race. It does not discriminate in who it holds in its grasp but affects all races, genders, ages and economic classes.

There are few offering real solutions. In a survey conducted by Platform Q Health, approximately 46 percent of clinicians surveyed answered that developing new non-addictive medications as well as making them accessible would have the longest lasting effect on our current crisis. We need better tools in our battle against addiction because just saying no and allowing patients to suffer in pain is not an option. Doctors want to alleviate pain without flaming the fires of this raging epidemic. While creating new therapies would be a great aid, the real solution is much more complicated and needs a many leveled approach.

What needs to be done to ease this crisis?

Easy access to recovery services. As a doctor, I struggle to locate rehabilitation services for my patents. Often there are waiting lists to be treated and an overdose can happen with just one episode of drug abuse. Delayed access puts lives at risk. Insurance companies often do not cover these services and they can be quite costly. If the state and federal governments want to continue to create initiatives and agendas to target the opioid epidemic, they also need to put funds into these programs and actually help victims recover. Political rhetoric without actual access to services will not help any of these patients and this will only fuel the flames of crisis.

Pharmaceutical companies need to take responsibility for their role in misleading healthcare providers and the general public regarding opioid medications. These companies are facing increasing and costly lawsuits for their role in fostering this epidemic. But rather than doling out funds for legal penalties, perhaps they can fund educational campaigns getting the truth out and developing alternative, non-addicting medications. It may not be as financially compelling as a $1000 a month cholesterol medication, but the time has come to call them to take responsibility for their actions, either voluntarily or by legal force.

Sanctioning of pill mill doctors needs to be strict. These doctors make it hard for all the rest of us. Doling out opioid prescriptions can be a profitable business, and some doctors are not immune to the allure. But, as doctors, they bear the most responsibility in public safety and ramifications need to be swift and severe.

We need better insurance coverage for non-medicinal therapies. Some of these therapies, such as acupuncture, massage, etc., may not be evidence-based, but some patients get much relief from their pain using them. Many people criticized pain as the "fifth vital sign" as being too subjective. But shouldn't the treatment then be based on subjective findings as well?

We need new non-addicting pain medications. Treating pain has never been harder. It is always a balancing act when a patient comes in complaining of pain. Stricter guidelines for prescribing opioids have been rolled out by many states. But they neglect the fact that there are not many alternatives. As it stands, doctors are under scrutiny for under-treating pain while at the same time being criticized for flaming the epidemic by writing too many prescriptions for scheduled pain medications.  We need new tools to treat pain. That is the only way this equation can be balanced.
       
While many people may blame the victim, my patient was only 16 years old when she came to me for help, an honor student up until the past year. She sat in my exam room begging for help with her mother sitting crying next to her. I tried to help her the best that I could, but there was just no help available to her. The system is not set to help these victims. How are we going to even try to curb this epidemic, affecting millions, when we can't even help patients at the individual level?  Who has the courage to look at the real face of this crisis?