Opioids’ rising death toll demands comprehensive policy solutions

Opioid use is much in the news these days: no surprise, given the exponential increase in opioid prescriptions during the past two decades. Nationally, there were 76 million prescriptions for opioids in 1999. By 2011, that number had increased to 219 million, a nearly 200 percent increase. Similarly, deaths from opioid use have exponentially increased. In Michigan, accidental overdose deaths from opioids (both prescription and nonprescription) increased by nearly 550 percent between 1999 and 2013, rising to 519 in 2013 from 81 in 1999.

Communities across the state and country are struggling with how to stem the tide of opioid-related deaths. In Washtenaw County, an interdisciplinary group including law enforcement, mental health professionals, emergency medical professionals, patient advocates and others formed under the auspices of the Washtenaw Health Initiative, to reduce opioid deaths in the county.

The group has worked together to implement Project Lazarus, a national model that helps communities prevent drug overdose deaths while ensuring that those with chronic pain get the treatment they need. In summer 2015, this WHI-sponsored initiative helped train and equip local law enforcement officers with naloxone, an overdose reversal drug, resulting in six saved lives between August and November.

Projects like the one in Washtenaw County are incredibly important: they focus on saving lives when an accidental overdose has occurred. To fully address the problem, however, there must also be a focus on prevention of overuse of opioids.

Some who suffer from chronic pain are worried that the intense press and policy interest in opioid use and abuse will mean that state and federal policies will be introduced to limit legitimate opioid prescribing for pain treatment.

Treatment of chronic pain is complex. According to the U.S. Interagency Task Force on Pain, 100 million people in the United States suffer from chronic pain. The national task force grew from a 2011 Institute of Medicine report that called for the development of a comprehensive strategy to deal with the treatment of pain.

The task force recommended a multimodal strategy, including team-based care that includes drug and non-drug interventions such as cognitive behavioral therapy. But even with these comprehensive approaches, opioid use is often a component of a treatment strategy. It is essential that whatever policies are implemented to help reduce overuse of opioids do not impede the care of those who suffer from chronic pain.

Something patient advocates, clinicians, and law enforcement can absolutely agree on is that care for patients with chronic pain should be coordinated between the multiple practitioners who may see a patient with pain. Too often, however, that care is not coordinated.

In a study by the Center for Healthcare Research and Transformation, we identified 600 patients in our study population who had received at least 10 opioid prescriptions from 4 or more providers within 3 months. While these patients represented a small percentage of all patients who received opioid prescriptions, they are clearly the ones most at risk of harm.

Recognizing the growing concerns about opioid abuse, Governor Snyder convened the Michigan Prescription Drug and Opioid Abuse Task Force in summer 2015. The Task Force released its report – and accompanying recommendations – last October.

The task force recommended several actions that will address issues related to patient safety and uncoordinated opioid prescribing, including more provider and consumer education and, importantly, improving and mandating that physicians and pharmacists use the state’s database of controlled substances prescribing.

Some of these recommendations may be controversial, but if we are going to prevent more deaths in Michigan from opioids, better coordination of patient care is essential. The recommendations of the state task force would get us a long way to that goal.

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

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Comments

Patrick Shannon
Sun, 01/10/2016 - 9:13am
Thank you. As a drug court judge, I see firsthand the destruction of lives and families. Opioid and heroin abuse transcends race, religion, geography and economic status. We need a local, county, regional and statewide public health model approach to this killer. Sign me up. It is obvious to me that DARE, Just Say No, and enhanced law enforcement investigative teams were not the answer. Part D, big pharma, government service silos and the healthcare industry maybe the unwitting accomplices in this modern epidemic. The Governor's Task Force was a start but I do not believe it was representative of the needs of Michigan. We live in a big and diverse state that stretches from Monroe to Sault Ste. Marie and well beyond Ann Arbor and Lansing. The crisis deserves more than a report to be shelved and reviewed at a later date.
Robert Burgess
Sun, 01/10/2016 - 9:33am
The drug companies which manufacture Vicodin, Oxycontin, etc., must be salivating. Who funded this so-called U.S. Interagency Task Force on Pain? The drug companies? We are lead to believe that 100 million people, nearly one third of the US population suffers from chronic pain which may require opioids? This sounds more like the British who wanted to sell opium to the Chinese than it does science to me. Drug pushers not medical professionals who are supposed to follow the Hippocratic oath. Or maybe it is the hypocrite oath?
Perry Taylor
Mon, 01/11/2016 - 9:15am
Please factor in the cost of disability benefits for all those with chronic pain who will no longer be able to work because others have abuses opiates. Perhaps the study should examine the impact on a person's mind and body who lives with chronic pain, and is unable to get prescription drugs to make the pain manageable? Solving one crisis in a silo only creates problems at some other point down the line of medical care.
Robert Burgess
Mon, 01/11/2016 - 2:56pm
There is NO way that there are 100 million people in the United States, nearly one third of the population that needs opioids. Doctors are NOT using the least troubling method to treat ailments if they are prescribing 259 million opioid prescriptions in a year. Instead, they are art best negligent and at worst drug pushers who should at minimum lose their license to practice medicine. Who are the doctors who are prescribing all of these prescriptions? These are controlled substances that are heavily controlled by the government. Why don't journalists publish the names of the doctors who are over prescribing? Take some Tylenol, Bayer Aspirin, or Alleve and stop telling people who have lost loved ones that we are creating problems at some other point down the line of medical care.
Cathy Carey
Mon, 01/11/2016 - 10:24pm
Robert, your advice "Take some Tylenol, Bayer aspirin, or Alleve" is condescending and just wrong." Don't you think a pain patient has tried that and every other option available before being prescribed an opiate? Either A) they don't work or B) the side effects rule them out. As a person with chronic pain for more than 25 years, I am allowed one opiod RX by my pain doc. Must usually see him every month to get a 30 day RX for the only thing that works. From time to time he will write the RX and will make it available if I drive out to his office and pick up the paper prescription. They can't be faxed to a pharmacy. I suppose there might be docs that are not as conscientious as mine. And yes, it's possible a patient or three might be getting around the regulations for dispensing the heavy duty meds. But let's not make assumptions that all pain patients are out to scam the system.
Robert Burgess
Tue, 01/12/2016 - 10:46am
Why is it that according to reports, Americans who are only 5 percent of the world's population are taking 80 percent of the world's opioids? Are the doctors in the rest of the world (Australia, England, France, Japan, etc.) wrong. Do Americans suffer from debilitating pain 16 times as much as their counterparts in other countries? Those statistics are from several years ago. It probably is worse now since we have not addressed the issue. Here is a BBC report on the matter: http://www.bbc.com/news/magazine-17963222 Assume that some some doctors are good ones and only prescribe on a very limited basis. Fact is that even those doctors rarely receive adequate training to recognize the symptoms of addiction and how to address it once it is detected. How many doctors or pharmacists verify that their patients who are prescribed opioids are not obtaining prescriptions elsewhere, other doctors or pharmacies? You are correct. Some folks need opioids. However, we as a country far over prescribe the chemical equivalent of heroin. As a result, overdoses now exceed automobile and gun related deaths in this country. Some 30,000 people a year die because of this. If life is precious, should we not be more concerned about that than drug companies, pharmacies and doctors making money by prescribing these meds?
Michael Jensen
Fri, 01/15/2016 - 6:20am
As someone who suffers chronic back pain caused from myasthenia gravis medication, I wish it was as easy as 'taking an asprin' or other over the counter medication. The fact is that in my case, the over the counter solution wasn't one. I had to go to a pain clinic and go on opiates just to function through the day. The problem exists now because people can become dependent and or misuse the drugs. I was lucky enough to see that living the rest of my life on them was not for me. I found other help. Count yourself lucky if you do not have chronic pain.
Anonymous
Sun, 03/20/2016 - 1:42pm
Of the 100 million Americans affected by chronic pain, 5 to 8 million use prescription opioids to treat their chronic pain conditions.
John Q. Public
Tue, 01/12/2016 - 12:48am
I have the feeling that the administration is concerned less about opioid abuse than it is about creating some six-figure civil service jobs for term-limited legislators to land in. Watch how a new division is created to "address this problem". It will be administered by a couple of former legislators with no technical expertise in the field, but vast knowledge of how to use the budget and procurement processes to reward political allies with lucrative contracts via "public/private partnerships."
mike
Tue, 01/12/2016 - 3:15pm
After my recent shoulder surgery, my orthopedic surgeon told me he would prescribe opiod pain killers. I told him I probably would not use them but to go ahead and write a script for a handful. My wife went to the pharmacy and filled the prescription for 90 norcos. As it turned out I never used them but took them to my local pharmacy where they have the yellow jug program. Our local pharmacist told me of the hundreds of pounds of unused opiod pain killers that are disposed of each year in Michigan. Here in northern Michigan we have groups who are trying to address the problem but none of them are holding the physicians responsible. Medical schools need to include in the education of our future doctors and pharmacists, not only the value of pain management but also the risk and great cost of addiction.
John S.
Fri, 01/15/2016 - 5:11pm
Preferences change as the result of addictive goods. It's likely that governmental efforts to restrict the supply of opiod pain medications will raise their prices on the black-market and just encourage new black-market suppliers or a switch by users to heroin. More supply will be imported from states outside Michigan. The task force recommendations seem like a sensible start and address some of the root causes of the problem (physicians who are ignorant about pain management and/or ethically challenged; patients with pain who are ignorant about the potential for and consequences of addiction).