In the last week or so, two important studies have emerged indicating that the opioid crisis may be at its worst point ever.
The first study comes from the Centers for Disease Control and Prevention (CDC), a federal agency tasked with studying – and stopping – the spread of diseases, including everything from viral infections like the flu to mental health issues like drug addiction. Published in the agency’s monthly Vital Signs report, the study demonstrates that the number of opioid overdoses increased by 30% in a little more than one year from July 2016 to September 2017.
The second study comes from a group of VA medical personnel and public health researchers publishing in the Journal of the American Medical Association (JAMA), who wanted to learn how effective opioid prescription drugs were at managing long-term and chronic pain. As it turns out, opioid drugs showed less efficacy than non-opioid pain medications over a 12-month period – and in fact, over time opioids became worse for patients who had to deal with side effects that patients taking non-opioid medications did not have to deal with.
Taken together, these two studies show that current opioid drug policies, procedures, prescription practices and standards of patient care clearly need to be rethought.
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Fighting the Opioid Epidemic on Two Fronts
In the United States, we have been fighting a losing battle with opiates for a long time now. According to at least one study, Americans consume approximately 80% of the world’s opioid drug supply. Given that painkillers make up the one of the largest classes of drugs manufactured around the globe, second only to cancer drugs, this is a rather staggering statistic: According to the CDC, more than a quarter of a billion prescriptions for opioid painkillers were written in 2013, the latest year for which data is available, and that number has almost certainly risen in recent years.
As these two latest studies show, not only are we losing the battle against opioid use – and, more importantly, abuse – but the battle itself is largely one that we should never have had to wage in the first place. A large portion of people who become addicted to opioids do so after receiving a prescription for long-term pain management. But as the JAMA study shows, it appears opioids are actually worse at managing chronic pain than non-opioid medications.
Patients have to take larger and larger doses in order to receive the same benefit as they previously did with smaller doses.
The primary reason for this is that opioids come with a host of side effects, the most severe of which is that over time people tend to build up a tolerance for them. This means that patients have to take larger and larger doses in order to receive the same benefit as they did previously with smaller doses. This has been long known by doctors and researchers, and it is reinforced in the results of the JAMA study. Participants reported that opioids were more effective than non-opioids early in the study, but at around six months they started to report that opioids the same or even less effective at managing pain than their non-opioid counterparts.
Other side effects include nausea and vomiting, mental health problems (including everything from confusion to depression), and full-blown chemical dependence. Then, there are the problems associated with opioid withdrawal. The upshot of all these side effects is that, even when opioids are working, they well may wind up causing the patient harm in other ways.
Combined with the increase in overdoses, the fact that opioids are less effective than presumed creates a substantial public health problem. We are throwing large sums of public and private money at treating opioid addiction and related issues caused by a problem that could have been completely avoided by using more effective (and less habit-forming) medications.
Scrambling for a Solution to the Opioid Problem
As with most issues that cross social, cultural and political divides, people in many different areas are looking for ways to address the addiction problem that has arisen while simultaneously working to prevent future addictions. The good news is that these two recently published opioid studies could provide the key findings that give us a clearer path.
For one thing, it seems pretty obvious, given the reduced effectiveness of opioid painkillers over time, that doctors need to start finding newer and better ways to treat long-term and chronic pain. This includes not only researching and developing safer medications, but a wider embrace by the medical community of complementary therapies, such as meditation, yoga, tai chi, and massage – all of which have been shown to reduce pain in multiple studies. Awareness about these alternative pain relief methods could be included as part of a program that provides opioid training for doctors and other medical staff.
Most Commonly Prescribed Opioids
- oxycodone (OxyContin, Percodan, Percocet)
- hydrocodone (Vicodin, Lortab, Lorcet)
- diphenoxylate (Lomotil)
- morphine (Kadian, Avinza, MS Contin)
- fentanyl (Duragesic)
- propoxyphene (Darvon)
- hydromorphone (Dilaudid)
- meperidine (Demerol)
For another thing, public policy on illegal drugs needs to be significantly reconsidered, especially for less-addictive drugs like marijuana. A study published last year in the American Journal of Public Health showed that legalizing marijuana for recreational use can significantly reduce the number of opioid deaths. Considering there have been no known reports of a marijuana overdose ever according to the U.S. Drug Enforcement Administration (DEA), that seems like a pretty good tradeoff from a simple public health policy perspective.
Another way to fight the problem is to increase the availability of opioid agonist drugs, such as naloxone, not only to health care providers and emergency department staff but to trained first responders and others as well. Naloxone reverses the effects of both prescription opioids and illegal drugs, such as heroin, and it can be an important first step toward helping those with substance use disorders become well.
Finally, there have been increasing calls to hold drugmakers accountable for marketing tactics and self-funded studies that may have overblown the effectiveness of their drugs. Many state, county, and local governments are bringing opioid lawsuits against pharmaceutical companies in an attempt to offset costs for public health services that have been used to treat addictions and other medical conditions caused by opioid abuse. Even President Trump recently threw his hat in the litigation ring when he called for a federal lawsuit against Big Pharma as one way of addressing the opioid crisis, and the Department of Justice recently agreed to provide its data on prescription opioid sales to states and municipalities that are pursuing lawsuits.
While we haven’t figured out the best way to solve the problem yet, studies like the two published earlier this month give us more data in combating the terrible effect that opioid drug abuse has had on our country and around the world. Hopefully policymakers, prescribers, and health care administrators will see these studies, along with all the other evidence, and do what is necessary to stop the growth of this problem – and possibly even reverse it.
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