Addiction
October 28, 2019
Though opioid deaths havesubsided slightly from their record high levels in 2017, addiction and overdoseare still sweeping the nation. Thankfully, our city, state, and federal governments are fighting back. Policy proposals have tightened regulations andincreased the availability of medication-assisted treatment (MAT). Our criminal justice system has begun topursue alternative treatment programs where possible to help those struggling withsubstance use overcome their addictions.
States have also chosen to fightback through their Attorneys General, filing lawsuits against firms who make,distribute, and market opioids to hospitals and pharmacies around thecountry. Charges range from deceptivemarketing to working with pharmacies to thwart inspectors and regulators. And the courts are siding with theplaintiffs: distributors including McKesson and Cardinal have paidout millions in settlements, as have drug manufacturers such as Perdue Pharma and the Reckitt Benckiser Group (RBGroup).
The problem doesn’t end with thecompanies at the top of the ladder. Pharmacies are also coming under scrutiny for excessive orders ofopioids, and many doctors have been arrested for overprescribing the drugs.
Before the opioid crisis cameinto the public eye, there was little attention to restrictions andregulations. The Drug EnforcementAdministration has insufficient resources to track all opioid sales, as dostate-level agencies. Distributorsthemselves either lacked internal mechanisms to flag suspicious activity orknowingly ignored and overrode such warnings. As a result, pharmacies stocked opiates at levels that far exceededreasonable demand.
Today, the United States accountsfor over 80% of opioid pill useworldwide. Prescriptions for opioids have increasedfourfold since 1999. And opioids,including heroin, began causing a larger percentage of overdoses in the USduring that time.
The problems set in when thesedrugs reached their final targets: patients in need of pain relief. After being reassured by drug manufacturersthat medications such as oxycodone were not addictive, doctors began to prescribeopioids whenever they could to reduce patient pain. And, despite the manufacturers’ guarantees, prescription opioids are misusedby around 25% of patients, and more than 10% go on to develop an opioid addiction. Studies have also shown that family membersof these patients are more likely to overdose on opioids than those whose lovedones do not have a prescription. Thesestatistics have led some lawmakers to suggest increased security measures onthe pill bottles themselves.
It’s clear that the flood ofopioids into patient hands has been a factor in the rising rates of addictionand overdose. The question of whetherthis problem can be solved through our court system remains unanswered for now.
Though the settlements ordered bycourts have yielded nearly a billion dollars, that money is a drop in thebucket compared to the profits of many pharmaceutical giants. Even for companies like Insys, which filed forbankruptcy after having to pay out a large settlement, the fight isn’t over.
Insys is trying to use bankruptcy protections to protect themselves fromhaving to defend themselves against thousands of lawsuits filed againstthem. Perdue Pharma has considered doingthe same, hoping that internal changes will be enough to protect them fromhaving to shut down completely. Meanwhile,the larger firms continue to pump out opioids as fast as they can, unwilling tolet their cash cow go.
The scientific community is spliton whether decreasing access to opioids will help or hinder the fight againstthis crisis. On the one hand, there isclear evidence linking the prevalence of prescription opioids with the rise inopiate addiction and overdose rates. On theother, current users have developed a dependence on prescription opioids mayturn to more dangerous options like heroin or fentanyl.
However, with prescription ratesvastly outpacing those in the rest of the world, America can protect patientsby finding other solutions. Opioids havelimited effectiveness for pain relief, as patients’ tolerances risequickly. Plus, the longer patients takeopioids (or the higher dosages prescribed), the more likely they are to developan opioid use disorder. This combinationis putting patients, especially those who need long-term pain relief, in aplace where opioid misuse and addiction becomes more likely. For these individuals especially, a bettersolution is needed.
With doctors facing limits whenthey prescribe opioids, other pain management techniques are having arenaissance. Non-drug-based options suchas physical therapy, acupuncture, and the like may help some patients goprescription-free. In other situations,where prescription painkillers are needed, doctors have literally hundreds ofoptions to choose from.
This pivot to ahighly-individualized response rather than a one-size-fits-all prescription maytax doctors’ already busy schedules, especially given their lack of training on painmanagement. It is also much easier to prescribe apainkiller than it is to identify the root cause of any pain—which may bepsychological rather than physical. Thehigher time investment is likely one of the reasons behind medicalprofessionals’ choice to prescribe opioids so frequently.
Doctors may have also found thatprescribing opioids helped increase their finances. Insurance pays much more on average forprimary care than for behavioral care, meaning services can be billed at higherrates. It also pays for doctors to fitin as many patients as possible each day, which disincentives the longerconsults necessary to craft a personalized plan for patients. The overprescription of opioids may have beenas much a systemic problem as anything else, and further changes will be neededto encourage responsible and appropriate prescriptions.