Here’s how to address America’s dual pain and opioid crisis.
The current opioid crisis is described in terms such as “the opioid epidemic”, or “the deadliest drug overdose crisis in US history.” The statistics are indeed staggering. 72,000 people died of drug overdoses in 2017. This is a new record. And two thirds of those deaths were related to opioids. Most of those opioid-related deaths were caused by illegal drugs such as heroin and fentanyl, but the roots of the problem go back a decade or so to an era of relatively unregulated use of prescription painkillers.
Politicians often see the crisis of opioid use as a vote generating mechanism. Their strident calls for action have sometimes resulted in overreaction.
Keith Humphreys is a drug policy expert at Stanford University. According to Humphreys, imposition of strict, all-encompassing, and inflexible limits on opioid use represents the wrong approach. He predicts that inflexible caps on opioid prescribing “will cause a lot of suffering” for pain patients who actually need opioids and aren’t in danger of abusing them.
“There is a problem if you don’t give doctors flexibility, because there are exceptions”, said Jane Ballantyne, president of Physicians for Responsible Opioid Prescribing (PROP). “But at the same time, if you don’t have guidelines to reflect what should be done in most cases, it’s very hard for there to be any control at all in prescribing.”
Instead of inflexible one-size-fits-all rules, experts suggest protocols that make doctors more aware of the consequences of over-prescription. A report in the August issue of Science described a study conducted in San Diego.
- Researchers learned of opioid overdose deaths.
- Letters describing those deaths were sent to 388 doctors who had prescribed opioids to the patients who had overdosed.
- A control group of 488 physicians, who also had patients who died from opioid overdoses, were not sent letters.
- The doctors who got the letters prescribed nearly 10% fewer opioids after receiving the news their patients had died. (The prescription rate in the control group was unchanged.)
What’s the difference between dependency and addiction?
Experts agree that recognition of the difference between dependency and addiction is a crucial step on the path toward appropriate action. Addiction is substance abuse. It’s compulsively using a drug despite negative results. Scott Gottlieb, Commissioner of the Food and Drug Administration, says addiction is, “The continued use of opioids despite harmful consequences.”
Patients can be dependent upon opioids and lead normal, productive, happy lives
This doesn’t qualify as addiction, and it may not need correction. Andrew Kolodny, who studies opioid policy at Brandeis University, says, “There are a lot of people you that should, really, just leave them alone if they are on modest doses.”
In cases of addiction, where opioid use is causing more problems than it’s fixing, the answer is simple. Treatment. But effective addiction treatment is still inaccessible in much of the United States. Some states are taking the steps necessary to make sure those addicted to opioids can get the help they need, but much more needs to be done.
Where access to treatment is accessible, multiple treatment modes are often available. Treatment protocols that require abstinence from drugs have the longest proven history. Those modalities can include physical therapy, mental training such as cognitive behavioral therapy, and group recovery such as is practiced in twelve-step programs.
Medication-assisted treatment is gaining acceptance
Although there remains some controversy about their use, medication-assisted treatment (MAT) programs are rapidly gaining acceptance. MAT uses opioids to fight opioids. Methadone and buprenorphine (Suboxone) are prescribed and administered under controlled conditions. Because they are opioids themselves, they can stave off withdrawal symptoms. And they don’t provide the euphoric high that leads to misuse of other opioids, so they are less likely to result in addiction.
MAT can arouse skepticism among treatment professionals. They level the claim that MAT is just substituting one drug addiction for another drug addiction. However, the research shows MAT can cut the mortality rate among addiction patients by half.
The well-respected Hazelden Betty Ford Foundation has long advocated abstinence-based treatment. However, in 2012, Hazelden began providing MAT. “This is a huge shift for our culture and organization,” said Marvin Seppala, chief medical officer of Hazelden. “But we believe it is the responsible thing to do.”
New pain management techniques are gaining recognition
In the medical treatment arena, new surgical intervention techniques are gaining recognition, approval, and effectiveness. Spinal cord stimulation (SCS) devices deliver mild electrical pulses to nerves along the spinal column. The pulses interrupt pain signals before they reach the brain.
SCS essentially tricks the brain into feeling only numbness or a mild tingling sensation, instead of the constant searing agony of incurable chronic pain.
The next step forward from SCS is dorsal root ganglion stimulation (DRG). DRG provides a far more tightly focused disruption of pain signals before they can get to the brain.
The nation is searching for a balanced solution to the opioid crisis
For decades pharmaceutical manufacturers reaped vast financial rewards from the more or less unregulated prescription and sale of opioid painkillers. The true cost of that deadly harvest, measured in lost and shattered lives, has now been widely acknowledged.
Medical practitioners, motivated by new laws and regulations, both federal and state, are rapidly shrinking their opioid prescription practices. There’s a real danger the regulatory pendulum may swing too far. Medications that make life bearable, or even productive, may be denied for many patients. We’ll keep you posted as the nation looks for a balanced solution.
Why Nuvo Spine and Sports is your best choice for pain management
We approach our work armed with tried and true medical techniques and state-of-the-art regenerative strategies bred from sports medicine and the neurological sciences.
The Nuvo team of medical professionals is solely dedicated to minimizing or eradicating pain by resolving the underlying conditions that cause the pain. We are proud that we consistently achieve that goal and successfully enhance our patients’ overall quality of life.
To request more information or schedule a consultation, please call (888) 370-9334 or make your appointment online.
Read the full article at: www.vox.com
Dr. Vahedifar's pain management strategies integrate cutting-edge medical technology with targeted interventions to minimize pain and treat pain’s underlying causes.
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