The Centers for Disease Control and Prevention (CDC) estimates that 44 people fatally overdose on prescription opioids daily in the U.S. That exceeds the daily number of deaths caused by motor vehicle crashes.
One forecast estimates that as many as 650,000 people — nearly the combined population of the cities of Arlington and Plano — could die from opioid overdoses alone in the next decade.
The epidemic is so pervasive that it is actually causing the average U.S. life expectancy to fall, according to a new study. The dramatic rise in drug overdose deaths is largely to blame, according to the study. It found that, overall, life expectancy at birth increased by about two years between 2000 and 2015. But drug overdose deaths made that number significantly lower than it would have been otherwise — by more than three months.
Today, Americans’ eyes are wide open about the danger of opioids. Nearly half say prescription painkillers are a “crisis” or “very serious problem” where they live. And recent research suggests that opioid abuse could be harming the economy by cutting into the available U.S. workforce.
The roots of the epidemic
But how did we get to such a desperate point?
The opioid epidemic began in the 1990s, when physicians were required to begin recording patients’ pain level as a standard vital sign. This raised the expectation that doctors should treat pain as a requirement of quality care.
Pharmaceutical companies encouraged doctors to prescribe opioids to treat all sorts of pain, often using misleading marketing about the medication’s safety and effectiveness. Doctors, many at wits end with difficult-to-treat pain patients, forged ahead — in some states, writing enough prescriptions to fill a bottle of pills for each resident.
In many cases, due to the pressure to meet patients’ demand for pain relief, physicians prescribed too much medication. After surgery or an injury, they often ordered several weeks worth of pills when a one-week supply would have been sufficient. Patients ended up with an ample supply of leftovers.
This type of painkiller addiction is dangerous enough, but even more concerning is its gateway to more powerful opioids. Some patients who lose legal access to painkillers turn to illegally obtaining cheaper, more potent opioids like heroin and fentanyl, powerful synthetic drugs. In fact, a 2014 study found that 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the CDC found that people who are addicted to painkillers are 40 times more likely to become addicted to heroin.
How we’re responding
Baylor Scott & White Health is doing all it can to protect its patients from the potential harm of painkillers known as opioids.
“Opioids aren’t evil,” said Judy Embry, Ph.D., a family medicine psychologist on staff at Scott & White Family Medicine Clinic – Sante Fe in Temple, Texas. “They are an important part of pain management. But they need to be used and kept safely. For most conditions, they should be used for a short time only to reduce risks and side effects.”
Robert Probe, MD, chief medical officer for Baylor Scott & White Health, said the system’s clinical leadership council made opioid education a priority earlier this year.
“(Pain management) was not well taught in medical schools,” he said. “In fact, there was a lot of pressure to make sure we were addressing people’s pain. Doctors were doing that with opioids. There is so much new information that we need to get out there.”
That education includes a 90-page guide for physicians, continuing education courses and a video series with the latest information. Dr. Probe said the system also combed electronic health records to identify providers who were frequent opioid prescribers and made them more aware of alternative pain-management tactics to enhance patient safety.
“We recognized the deficiencies in (pain management) training,” Dr. Probe said. “We created training that is easily accessible to all of our providers.”
A collective effort
As the dangers of opioid abuse and addiction become an increasingly popular topic of conversation, many people are open to seeking drug-free alternatives. Patients are often encouraged to explore other treatments for chronic pain, such as non-opioid medication, special exercises, dietary supplements, yoga, meditation and cognitive behavioral therapy.
Nearly eight in 10 Americans say they prefer to try other ways to address their physical pain before taking prescription painkillers, according to Gallup.
But for those already dealing with opioid addiction, it’s a different story. According to a surgeon general’s report, only 10 percent of Americans with a drug use disorder are able to get specialty treatment, primarily because of a shortage of treatment options. But through increasing awareness and education efforts, we’re hoping to change that.
Tim Clark, Ph.D., a neuropsychologist at Baylor Pain Management Center in Dallas, runs a 12-day program over three weeks to equip patients with alternative tools to cope with pain. He said that weaning patients off painkillers can be extremely difficult if they are not provided the proper tools and support.
“We have more people on opioids for chronic pain and there is no off-ramp,” he said. “(Weaning people off painkillers) can create a second crisis for patients.”
Clinical leadership at Baylor Scott & White Health is committed to educating its medical providers on the latest evidence regarding chronic pain physiology and therapy. The goal is for everyone to understand the science that underlies current best-practice recommendations for treatment of pain, for physicians to utilize this evidence as they treat their patients who have chronic pain, and for patients to understand there are effective non-opioid treatment options. The hope is that providers will share common understanding, patients will hear a consistent message and the community will support these efforts.
As our nation’s conversation is turning more and more toward how to solve this opioid epidemic and help those struggling with addiction, we all have a part to play.