We have been talking about the opioid addiction in America for several months now, from Congressional hearings, to new Centers for Disease Control (CDC) guidelines, to what solutions exist for patients and their loved ones. In response to the epidemic, CNN hosted a program entitled “Prescription Addiction,” hosted by Anderson Cooper and Dr. Sanjay Gupta.
The program featured guests including: addicts of opioids and heroin, family members of addicts who are no longer “themselves,” family members of addicts who have passed on due to their addictions, physicians, treatment center owners, and others, and was a question and answer session on the impact the epidemic has had on the country, and potential solutions.
Co-host Sanjay Gupta opened by calling the current opioid epidemic a “preventable” and “man made” epidemic. Dr. Leana S. Wen, the Baltimore City Health Commissioner, has been visible during many conversations on the epidemic, frequently speaks on the importance of doctors following guidelines and patients being involved in their medical care. During the special, she mentioned that patients should ask questions of their physicians, such as do I need this medication? What are the side effects? What are the alternatives available to me?
While many panelists and participants acknowledged that many doctors want to do the right thing, and do not go out of their way to perpetuate the epidemic, they focused on the idea that it is important that doctors review each individual patient and make a determination on whether or not to prescribe opioids based on individual situations, not general ideas.
Another reason behind the epidemic, and why America is disproportionately affected compared to the rest of the world, Dr. Wen believes, is that America is overprescribed. Patients are looking for a pill for every problem, and that culture needs to change before the opioid epidemic gets better. Dr. Wen as an emergency room physician tends to over simplify serious problems as there are many aspects to the opioid academic often left out of these discussions such as access to rehabilitation, alternative therapies, and the work being done to develop opioid alternatives.
Dr. Gupta believes, and other physicians agreed, that the FDA is in a tricky spot when it comes to this particular situation. That while they do need to continue approving more drugs, so patients have more options, they also act slowly when it comes to safety precautions. For example, they just recently approved black box warnings for certain drug classes.
Dr. Mark Rosenberg of St. Joseph’s, an opioid free provider, spoke to the fact that certain patients seek St. Joseph’s out specifically because of that policy. Such patients have either typically had an opioid addiction themselves, or have been personally affected by someone who has.
One solution idea to help those who are in the throes of addiction is to follow in the footsteps of Gloucester, MA. Gloucester’s police department allows addicts to come to the station, turn themselves and their drugs in, and instead of being taken into jail or criminally prosecuted, are helped and brought to addiction treatment centers. It takes a strong person to admit their addiction, but having a support system – and not one that throws them into jail – is an important step on the road to recovery. While it is important for police departments to be on this page, the program (including take back programs) should be modified to include pharmacies as locations for taking back drugs.
Additionally, several participants suggested that legislation against pill mills is not only common sense, but needs to be done sooner rather than later. A major concern by panelists and participants alike is the fact that some physicians (a small minority) are effectively glorified drug dealers. They engage in egregious behavior (beyond mere negligence or bad judgment), such as posting signs around the office that they are “Cash Only” and provide prescriptions and drugs without actually caring for the patient and evaluating their individual situation. The rationale behind prescribing opioids should always be to relieve the pain and suffering of the patient in front of them, after evaluating the options available for that patient.
Narcan/Naloxone are prescriptions that can help reverse an overdose from heroin or OxyContin. The prescriptions come in an an injection or a nasal spray, and can be helpful if a friend or family member is present when one is suffering from a narcotic overdose. However, the prescriptions are limited and need to be used shortly after the overdose signs appear. Even still, they have such a potential to save lives. Areas like New York actually allow the drug to be bought over the counter, and cities like Baltimore allow for a standing prescription for anyone who feels they need it.
The physicians acknowledged that while the DEA may be monitoring how many prescriptions physicians are writing, that isn’t the end of the story. Warnings from the health department tend to have no effect on the physicians who are engaging in the egregious behavior outlined above.
In sum, it is likely that this conversation will continue, with stakeholders and others continuing to speak on the topic. It is clear that this epidemic is troublesome, and that a solution is necessary. It is a matter of time to determine what those solutions may be, and how effective they truly are.