The U.S. represents less than 5% of the world's population, but consumes 80% of the world's prescription narcotics and 99% of the world's hydrocodone. (1)
We lose on average 50 people a day to prescription pain medication overdose (2).
According to the National Safety Council, 99% of doctors prescribe highly addictive opioids for longer than the recommend three days, with 23% prescribing a months worth. (3)
Every year, 73 million people undergo surgery and more than 98% of those patients receive opioids for pain control from their surgeon. (4)
Fifty percent of participants involving 45,000 patients received long-acting opioids for chronic pain not related to cancer. (5)
Question: What is the common denominator in the above facts?
Answer: The practitioners with prescriptive authority to write for opioid pain medication.
Doctor originates from the Latin verb, docēre, which means 'to teach'. We assist in healing by teaching our patients. We're here to teach them to take control of their health by giving them the information they need to make decisions on their life outside of the exam room. When they come in with an acute injury or illness, then we utilize our expertise to intervene quickly, treat the ailment and fix the suffering. Once they're stable, our responsibility returns to teach them how to maintain health. When it comes to chronic pain management, we're also here to teach them how to control pain. Yet, we've failed in this.
According to the White House Fact Sheet, ‘$1 billion in new mandatory funding over two years to expand access to treatment for prescription drug abuse and heroin use’. This includes ‘$50 million in National Health Service Corps funding to expand access to substance use treatment providers. This will ‘help support approximately 700 providers able to provide substance use disorder treatment services’.
First, 700 providers is the number of attendees at one national medical conference. The government could spend 1/100 of the 50 million dollars to train those healthcare professionals on substance use disorder treatment services in a single conference or workshop. Then spending can then be used to augment their training, by either delivering an online module or on-site education. This leaves a huge chunk to distribute towards targeting the root-cause of the opioid epidemic.
By training new providers instead of working with those already prescribing 80% of the global narcotic prescriptions, we’re going about it the wrong way. These ‘new’ providers will be treating symptoms with yet another drug. Yes, we need more providers to deliver medication- assisted treatment. Yes, we need this funding to prevent the deaths of those addicted to narcotics. Yes, we have to address the brain changes and withdrawal symptoms that occur when detoxing. But we also need to take a portion of the 1 billion and apply it towards education of those already treating pain with opioids. There are alternatives and though the answer lies in shifting the entire paradigm of healthcare, taking the time to educate our patients is a huge first step.
I recommend placing the teaching back into equation. The arsenal of options is quite broad, yet in our fast-paced modern medicine world, those alternatives are often overlooked. Time and education have to be an integral part of the healthcare experience and an aspect of the root- cause solution to the opioid epidemic. I’m not blaming our healthcare professionals, we’re forced to work on conveyor-belt mode. If we can shift the paradigm and get our hospitals administrators, clinic managers, chief medical officers to understand the urgency for quality and prevention over productivity and ‘treat and street’ medicine, we can help heal the opioid crisis from the ground up. Then we can take a portion of the 50 million and target two major healthcare provider populations, primary care providers (PCPs) and surgeons.
Providing funds towards teaching PCPs to develop protocols, screenings, guidelines, access to the pharmaceutical board and comprehensive specialist support would be one effective way of spending the $50 million. Also, training PCPs on techniques like trigger point injections, medical acupuncture, anti-inflammatory nutrition and supplementation, breathing exercises, and other chronic pain control tools that are used in successful pain management practices would help decrease the amount of opioids prescribed.
Next, a portion can be focused towards expanding surgeon’s toolkit on alternatives, since 98% of patients receive post-operative opioid prescriptions. Pain relief is a high priority in post-operative care, understandably. Clinicians have a duty to alleviate suffering that is why we went into this profession. Dr. Susan Downey, a board-certified plastic surgeon in Los Angeles, states that education is exceedingly important in the post-operative setting and one of the easiest specialties to remedy the opioid crisis, is surgeons. Setting up the expectation from the beginning and building a relationship is key. Then she’ll use medications like IV acetaminophen or long-acting non-opioid option, sedatives, anti-nausea meds to ease the pain and discomfort, so that narcotics are not needed. Integrating these options into everyday surgical practice, educating both patients and surgeons, allowing them to have the time for education could create another impactful shift in the paradigm.
We need to foster a healthcare system where providers get back to teaching and building relationships with patients. As long as the hierarchy of medicine exists and the chiefs and managers hold the puppet strings, this is a far-reaching possibility. We, as providers, have the ability to make monumental change through our practice and our actions and funneling a portion of the initiative towards providing that is imperative. In the case of the opioid epidemic, time and education are vital and our patients are waiting for to guide and educate them on the real road to health.
- https://www.asipp.org/documents/ASIPPFactSheet101111.pdf
- https://www.drugwatch.com/2015/07/29/drug-abuse-in-america/
- https://www.insurancejournal.com/research/research/national-safety-council-survey-of-doctors-prescribing-opioids/
- http://www.ncbi.nlm.nih.gov/pubmed/23553809
- http://www.claimsjournal.com/news/national/2016/06/16/271612.htm