The best way to mitigate its impact is to reform the structural problems in healthcare that created this national crisis
The opioid epidemic in the U.S. gained attention from the media and government as a serious problem plaguing our nation. While it is often viewed as a drug issue; it is an overall healthcare issue. The best way to mitigate its impact is to reform the structural problems in our healthcare system that created this national crisis in the first place.
Policy Efforts Aimed at Curbing the Opioid Epidemic
Recently the Obama administration has taken several actions to tackle the opioid epidemic including broadening access to medication-assisted treatment, improving prescription painkiller monitoring, and expanding research on pain treatment and opioid misuse and overdose. Although the Obama administration’s actions put us on the right track, more must be done to stop the addiction cycle before it starts and end the opioid crisis.
In March, the Centers for Disease Control and Prevention (CDC), developed the first-ever guidelines for dispensing addictive painkillers in order to combat the opioid epidemic. The guidelines urge doctors to avoid prescribing opioids for patients with chronic pain, noting that the risks of such drugs outweigh the benefits for some people.[i]
In light of the new guidelines, some physicians are now providing prescription checklists and requiring patients to sign “pain management contracts,” in which they must agree to random drug tests before receiving an opioid prescription,[ii] and others are implementing opioid prescribing guidelines.[iii]
However, physicians have had access to tools, including assessment forms for evaluating the use of controlled substances, which help them treat and manage pain appropriately for their patients. In light of the current opioid epidemic and its status as a public health issue, it is clear that physicians need to further evaluate their current screening methods for selecting pain management therapies – the development of the CDC guidelines, and others, are a direct response to that.
Individual states are also creating their own prescribing practice guidelines, such as best practices for managing opioids in the emergency department and throughout the hospital where prescriptions are written, to curb the amount of opioids prescribed to patients.[iv] This effort goes beyond traditional screenings conducted by an individual clinician to provide broader, standardized guidelines that address the epidemic head on.
Non-Opioid Pain Management Options
Some clinicians are still not aware of the detrimental near and long-term effects of prescribing opioids. In fact, data from the Mayo Clinic indicates that up to one in five patients prescribed opioid painkillers are at risk to progress to episodic or long-term prescription use.[v]
Clinicians and patients need to be aware of the many different types of non-opioid therapies that can be administered for pain management. Non-opioid therapies vary depending on what kind of pain the physician is treating. These therapies include nerve blocks, periarticular injections, neuraxial anesthesia and anti-inflammatory drugs. Solutions such as multi-modal therapies involving post-operative pain pumps are effectively low risk compared to opioids. In fact, with some pumps, patients experience a significant decrease in pain scores and narcotic use.[vi],9 Opioids are also too often prescribed for minor ailments, such as a toothache or a sprained ankle, when a non-opioid treatment would do.
Post-operative pain management is a critical element of recovery, but pain is often underestimated and undertreated. Each year, more than 73 million surgeries are performed in the U.S., and more than 70 percent may experience pain after surgery.7 It is crucial that physicians are aware of the different types of non-opioid pain management systems so they can administer the most appropriate non-opioid solution over an opioid solution, when possible.
Clinician education is essential to helping physicians mitigate the risk of opioid abuse. In August 2016, U.S. Surgeon General Dr. Vivek Murthy issued a warning letter to all U.S. physicians asking for their help in fighting the opioid epidemic through education, patient screening and the treatment of opioid abuse as a chronic illness.8 However, patient education is just as important as many patients may not completely understand the risks of taking opioid painkillers, and even more might not be aware that there are non-addictive alternatives. In fact, 72 percent of patients would choose non-narcotic pain medication for postsurgical pain management if offered the option.7 With more patient and clinician education, we can change the way a variety of conditions are treated and help to curtail the opioid epidemic.
About the Author
Roger Massengale is general manager of Halyard’s Acute Pain Division where he leads the North American Sales and Marketing organizations. Roger has over 25 years of medical device experience, where he has held leadership roles in Manufacturing, R&D, Clinical Research, Marketing and Business Development. Prior to Joining Halyard, Roger was the VP of Business Development for I-Flow Corporation, where he launched the ON-Q® Pain Relief System and led the acquisitions of InfuSystem, Spinal Specialties, Acrymed and Lifetech. He received a BS in Aerospace Engineering from UCLA and a Certificate in Business Management from UCSD. Roger has been granted over 100 U.S. and foreign patents in the areas of drug delivery and pain management.
[i] Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624-1645.
[ii] Hoffman J. Patients in Pain, and a Doctor Who Must Limit Drugs. 16 Mar 2016 [cited 2016 Aug 17]. In: The New York Times [Internet]. New York City: The New York Times c2016 – [about 2 screens]. Available from: http://www.nytimes.com/2016/03/17/health/er-pain-pills-opioids-addiction-doctors.html?_r=1
[iii] Matyola M. West Virginia Emergency Rooms Implement Opioid Prescribing Guidelines. 29 Feb 2016 [cited 2016 Aug 17]. In: WVAlways.com [Internet]. Bridgeport, West Virginia: WVAlways.com c2016 – [about 2 screens]. Available from: http://www.wvalways.com/story/31346939/west-virginia-emergency-rooms-implement-opioid-prescribing-guidelines
[iv] Stempniak M. How Hospitals are Fighting on the Frontlines of the Opioid Crisis. 2 Mar 2016 2016 [cited 2016 Aug 17]. In: Hospitals & Health Networks [Internet]. Chicago, Illinois: Health Forum Inc. c2016 – [about 2 screens]. Available from: http://www.hhnmag.com/articles/6924-how-hospitals-are-fighting-on-the-frontlines-of-the-opioid-crisis
[v] Hooten WM, St Sauver JL, McGree ME, Jacobson DJ, Warner DO. Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based Study. Mayo Clin Proc. 2015 Jul;90(7):850-6.
[vi] Sherwinter DA, Ghaznavi AM, Spinner D. Savel RH, Macura JM, Adler H, Continuous infusion of intraperitoneal bupivacaine after laparoscopic surgrery: a randomized controlled trial. Obes Surg 2008; 18: 1581-6.
7 Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesthesia & Analgesia. August 2003;97(2):534-40.
8 Vivek H. United States Surgeon General Letter. Aug 2016. [cited 2016 Nov 10]. Available from: http://i2.cdn.turner.com/cnn/2016/images/08/25/sg.opioid.letter.pdf
9 Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914-932.