While experts with different backgrounds all have subtly (or not so subtly) different ideas on how to deal with it, every single person I’ve interviewed agrees that this country is afflicted by addiction and has a serious problem with prescription opioid abuse.
According to my July 2 radio show guest, Dr. Andrew Kolodny, one of the nation’s experts on opiate addiction and the president of Physicians for Responsible Opiate Prescribing (PROP), the CDC, DEA, and FDA have all done studies that connect the addiction epidemic directly to an increase in prescribing practices. The prevailing belief is that the aggressive prescription of painkillers has led to this epidemic. Opioid over prescribing is a problem.
No one sets out to become an addict, but it is just so easy with opiate drugs because of their chemical make up and the effect they have on the pleasure centers in the brain. Patients get dependent (and believe they need it) they get tolerant (and need to increase dosages for the same effect) and they get addicted (the “cure” leads to the disease).
In my fascinating interview with Dr. Kolodny, he talks about the first great opioid epidemic in our country, the one in the early 1900s, when the Bayer company first offered heroin as a prescription pain killer. Opioid overprescribing became the norm. It was the only pain killer out there, (before then, I think there was only whisky and small blunt instruments to the head) and opiate addiction was a serious problem. But our country got this problem under control then, and one theory of how this occurred was that Bayer came out with aspirin, a non-addictive pain reliever. Doctors no longer had to prescribe heroin for diarrhea or a cough. By changing physician’s prescription practices, a national crisis was averted and the heroin problem all but vanished in this country for a quarter century.
Kolodny says, “One of the reasons we’ve had great difficulty bringing this epidemic under control, and in fact may be even the cause of the epidemic, is related to influence of the manufacturers of these meds who profit enormously from the overprescribing.” That is long what I’ve suspected.
So we’ve got a number of players here.
- The pharmaceutical companies who actively promote their product to increase their profit.
- The members of government who because of financial conflicts of interest, have been put in a position of customer service for the drug companies whose products they are supposed to regulate at the expense of the health of the citizens of the country they are supposed to be protecting and serving.
- The physicians who are caught in the rhetoric surrounding compassionate individual patient care and don’t demand more information about the products they are prescribing. Doctors don’t recognize these are heroin pills they are prescribing to their 15 year old patients with broken arms.
- Then there are the patients who aren’t aware of the questions they need to ask before they engage in filling their prescriptions, or who divert their unused meds into the black market intentionally or unintentionally without giving it a second thought.
Kolodny says we could control this epidemic the way we control any epidemic. With a two-fold treatment:
1) Prevent people from getting the disease and
2) See that people who have the disease have access to treatment.
But the most urgent of these might be #1. You prevent addiction to opioids by limiting initial contact. Make sure the medical community understands the risks and benefits of opioids. Also, he says, we could do a better job regulating the claims that pharmaceutical companies make to doctors. FDA is allowing these companies to make the claim that it is safe to prescribe in this way. Drug companies advertise these drugs as safe and effective. If FDA enforced the existing law that says a drug company is not allowed to do off label marketing, that off-label marketing of a drug is illegal, this would help. If they were not allowed to advertise for all common chronic conditions, that would reduce some of the overprescribing. In other words, these pills are not approved as treatment for fibromyalgia. These pills are not approved for long-term treatment of chronic pain and yet they are advertised and prescribed as if they are.
So, while it is a far more complex problem, the Physicians for Responsible Opioid Prescribing believes doctor education is a good place to start. We’ve all got doctors. Have we helped open their eyes?