We are failing the opioid crisis
Thursday, September 21, 2017
Our politicians are in the process of wasting tax dollars on ineffective and misguided efforts to resolve the opioid crisis. These funds will likely be spent by many of the people responsible for the crisis.
The problem is that politicians focus on demonizing medications instead of addressing human behaviors, which are the real underlying cause.
Suing drug manufacturers over presumed "failure to warn" will not result in any benefit to persons harmed by this crisis. More severe restrictions on opioid access and reducing production of opioids has a negative impact on patients who might benefit from these medications. These well-meaning actions also increase profits for criminals who will provide illegally sourced opioids to meet market demand.
The government's failure to understand the causes of this crisis is indicated by the metrics they use to measure their success. Tracking number of opioid doses manufactured or number of prescriptions written provides little useful information. These metrics are analogous to the police department touting anti-DWI success by noting a decrease in the number of gallons of gasoline sold.
A more informative metric would be the number of patients who take opioids, with long-term use and short-term use tracked separately. This metric could then be compared to the number of patients who experience an opioid misadventure. I have not been successful in finding a reliable source for this data.
To properly address the opioid crisis, we must focus on the human vectors that are driving this epidemic. While a small percentage of opioid abusers will always be motivated by their desire to get "high," a large percentage of opioid abusers began as mistreated chronic pain patients, progressing to become pseudo-abusers, and finally ending up as true abusers.
Pseudo-abusers and true abusers exhibit the same behaviors of lying, stealing and use of multiple providers in order to obtain opiates. The difference between the two is that pseudo-abusers are the product of failed treatment, while true abusers are the product of their own appetites.
We can minimize the pseudo-abuser component of this crisis by providing proper therapy to chronic pain patients. This requires performing an initial hour consult/education session with the patient.
Most prescribers can't devote an hour to a single patient. However, pharmacists who have been properly trained and given a mechanism to bill for this service could make a valuable contribution in this regard. They could also provide the necessary follow-up. I have a program in development that will provide this training.
If we continue to treat chronic pain patients with short-acting opioids and do not properly educate the patient prior to start of therapy, we will fail in our attempts to resolve the opioid crisis. Patient education, setting realistic Wong-Baker Faces pain score goals and making sure the patient understands the important role that mood and stress reduction provide in controlling chronic pain will provide a mechanism to have a positive impact on resolving the opioid crisis.
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