The final word: The opioid epidemic: Let’s keep working
On Aug. 10, the opioid epidemic was declared a national emergency – a designation befitting a crisis that has ensnared and destroyed many American lives. The statistics are truly staggering. Overdose has become the leading killer of Americans under the age of 50. Analysts predict that more than 60,000 patients will die of overdoses in 2017; the majority of these deaths will be attributed to opioids. An estimated 12.5 million Americans admit to abusing opioids, and more than 2 million report being dependent on them. Last year alone, the opioid epidemic cost the United States an estimated $78.5 billion. In addition, communicable diseases such as HIV and hepatitis C are experiencing a commensurate boom; the incidence of new infections for the latter have tripled since 2010. Despite the known risks of these dangerous narcotics, more than one-third of Americans received an opioid prescription in 2015.
Colorado can take pride in the fact that it is a low opioid-prescribing state. Although our population continues to grow, the number of opioid prescriptions has fallen by 13.3 percent over the past three years and prescription opioid overdoses have declined by 6 percent in the past year (although overdoses from heroin continue to increase). Despite the shortcomings of the Prescription Drug Monitoring Program (PDMP), physician utilization of the system has increased by 122 percent since 2014. While these trends are encouraging, they are just a beginning. If we are to reverse decades of liberal opioid prescribing practices and address the neglected needs of the masses who struggle with addiction and drug misuse, we must do more.
Although there is much debate about the multitude of factors that created the opioid epidemic – from the influence of pharmaceutical companies, to patient satisfaction scores, to misguided regulations, to the disproven and disastrous concept of pain as a vital sign – we must also accept that clinicians played a central role in creating the largest public health crisis of our time. We overprescribed. We underestimated risk. We harmed many of those we intended to heal. While our actions may have been rooted in good intentions, the results have been disastrous. In acknowledging our errors, we can begin to reform our practices and reverse these grim statistics with resolve, purpose and innovation.
Your own medical practice is the best place to start. Ask yourself if you are doing everything you can to address this epidemic. Have you reduced your opioid usage? Do you communicate with your patients about the dangers of opioids when prescribed? Do you treat addiction as a medical disease, not as a moral failing? Have you integrated harm reduction into your practice? Are you an expert in multimodal pain control strategies and alternatives to opioids (ALTOs)? Have you considered what role you can play in treating patients with addiction through medically assisted treatment or partnership with appropriate practices?
If any of these questions give you pause, we invite you to explore the resources available through the Colorado Medical Society, the American Medical Association, the Colorado Consortium for Prescription Drug Abuse Prevention, the American College of Emergency Physicians, and many of our other national and regional partners. All you have to do is ask – CMS is here for you.
Across our state efforts are underway to address the opioid epidemic. As this article goes to press, the Opioid and Other Substance Use Disorders Interim Study Committee, a cohort of 10 Colorado legislators, is finalizing several new prospective state policies and laws addressing opioids and substance abuse. CMS has collaborated closely with these lawmakers to ensure that potential legislation addresses the crisis both adequately and safely.
Colorado is also home to one of the largest opioid safety pilot studies in the nation; clinicians in emergency departments across the state are utilizing alternatives to opioids as first-line agents for pain control, and are evaluating their role in reducing opioid usage. Opisafe, a new medical app, holds great promise for making access to the PDMP less onerous for clinicians. Finally, the Colorado Consortium continues to bring together stakeholders, CMS among them, to address the opioid crisis through medical and community-based initiatives. We encourage you to join the movement by attending the organization’s annual meeting on Oct. 19 (www.corxconsortium.org).
The Colorado Medical Society stands with the families and patients afflicted with opioid addiction and misuse. We honor our colleagues who compassionately and dutifully care for the citizens of our great state. We realize the enormity of the task that lies before us as we confront the opioid crisis; it is incumbent upon physicians to lead the charge. CMS thanks you for your service and promises to be a resource and a partner to you. Together, we can begin the process of curing the state and our nation of this deadly epidemic.
Posted in: Colorado Medicine | Final Word | Initiatives | Prescription Drug Abuse