Special Topics in Pain: Opioids

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Ending the Opioid Epidemic---A Call to Action.

Author(s): Murthy V H, et al.
Journal: N Engl J Med. 2016; 375(25):2413-2415. 5 references.
Reprint: Vivek H. Murthy, MD, MBA, Office of the Surgeon General, Department of Health and Human Services, Washington, DC.
Faculty Disclosure: Abstracted by N Walea, who has nothing to disclose.
Objective: Review and evaluate the latest advances and newest information in the area of Opioids

Editor’s Note: this is an extraordinary article, published in the New England Journal by the surgeon General calling for healthcare providers to help in combating opioid abuse. 2.3 million doctors, nurses, dentists, and other clinicians were sent a letter and a color coded card describing safe opioid prescribing. In August 2016 the FDA also mandated a REMS update which will be released in February of March 2017. If you prescribe opioids, these activities deserve your attention. Opioid use by prescription and Heroin use are on the rise.

Class:   Pharmacology: Opioids-public policy

On August 24, 2016, a letter and pocket card was sent by the Office of the Surgeon General to 2.3 million doctors, nurses, dentists, and other clinicians asking them to help address America's escalating opioid epidemic. They are part of a larger campaign--Turn The Tide Rx--that also includes an online pledge for clinicians, educational resources, and an invitation to share experiences with colleagues about how to address opioid-use disorder, commonly referred to as addiction.

The annual number of overdose deaths involving prescription and illicit opioids has nearly quadrupled since 2000, and this increase parallels marked growth in the quantity of opioid pain relievers being prescribed. Prescription opioid addiction and misuse are also contributing to resurgence in heroin use and the spread of HIV and hepatitis C.

The Department of Health and Human Services has invested millions of dollars in treatment programs, access to naloxone, and prescription-drug monitoring programs, and the Centers for Disease Control and Prevention has developed opioid prescriber guidelines. Although 20 million people have secured health care coverage through the Affordable Care Act, there are still millions more who need it, particularly in states that have yet to expand Medicaid.

The opioid epidemic cannot be solved by government alone. It will require the engagement and leadership of all segments of society, particularly clinicians. Clinicians have a unique responsibility to address this epidemic. Clinicians can sharpen prescribing practices and use prescription-drug monitoring programs to reduce the risk of opioid misuse and overdose. Medical professionals can ensure that the recognition and treatment of opioid-use disorder is a universal aspect of training and part of every clinician's toolbox.

Clinicians can use their voices to call for a more effective approach to opioid-use disorder in our health care institutions, in our communities, and in our government. As leaders in society, clinicians can help change how our country sees addiction--not as a personal failing but as a chronic disease of the brain that requires compassion and care. Eradicating the bias against addiction that too many people--including some clinicians--still harbor will be essential to creating an environment where people feel comfortable coming forward and asking for help. 

The ability to address the opioid epidemic will also depend on a willingness as a society to be clear-eyed about what is working and where gaps still exist.  Clinicians are urged to consider nonopioid pain-treatment alternatives in their practice. But it must also be acknowledge that more needs to be done to make these alternatives affordable. The pharmaceutical industry, payers, academia, and government will have to work together to develop addition safe alternatives to opioids and ensure they are accessible to patients.

Health insurance plans must treat substance use disorder the same way they treat other medical conditions according to the Mental Health Parity and Addiction Equity Act of 2008. More accountability is required to ensure that this promise is fully reflected in payer practices.

Finally, medical professionals have to do all these things without allowing the pain-control pendulum to swing to the other extreme, where patients for whom opioids are necessary and appropriate cannot obtain them.

Important Points:
Society still looks to the medical profession for help and for hope during difficult times. This is one of those times. This is a moment for clinicians--who have dedicated their lives to providing compassionate care to others-- to be not only caregivers but also the leaders and advocates that our communities need.

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