Americans need to ditch opioids for more effective and safer alternatives

Americans need to ditch opioids for more effective and safer alternatives
© Smartstock/iStock/Thinkstock Photos

Everyone is aware of the potential harm from opioids, but opioids are not a new problem. The 1970s were tainted by a heroin epidemic that was largely viewed as a problem of minorities with moral failings. The cultural attitudes toward opioids and people who abused them were seeded by cultural campaigns and legal efforts to fight the increasingly popular "war on drugs."

In the 1990s there was a dramatic shift in attitudes when opioids were being recognized as a viable treatment option for people in chronic pain. Physicians were rightly convinced that people with moderate to severe pain deserved compassionate treatment, and they had evidence that opioids could afford relief.

ADVERTISEMENT
Their attempts to help reduce the disability of pain led to aggressive opioid prescribing, mainly because there were few other options that were affordable, effective, and legal. Even now, there are few viable alternatives to opioids.

 

The increased prescribing has been associated with increased societal harm from opioids, including overdose deaths. Reducing the number of opioid-related deaths is an important goal, and it was the impetus for the 2016 creation of the Centers for Disease Contol and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain.

But policies geared toward simply reducing the amount of opioids prescribed will not solve the problem. This is clear, because even though the amount of opioid prescriptions has declined since 2012, the number of overdose deaths has continued to increase.

"Illegal street drugs, not prescriptions, [are] now powering opioid abuse," according to STAT News. Reducing the amount of opioids prescribed apparently has pushed people who feel a need for an opioid to illicitly obtain whatever they can find.

"That represents a dramatic change in the way opioids have traditionally been abused, and means public health officials will likely have to adjust their response to the two-decade-long crisis," STAT News notes. The fact that street drugs are unregulated and often more lethal than prescription opioids has contributed to the continued increase of overdose deaths.

That reality is being overlooked by many politicians, law enforcement, and advocates whose sole interest is to reduce the amount of opioids prescribed. Most still believe the root cause of the problem is inappropriate, excessive prescribing.

In fact, Attorney General Jeff SessionsJefferson (Jeff) Beauregard SessionsCurtis wins Chaffetz's former Utah House seat Overnight Cybersecurity: What we learned from Carter Page's House Intel testimony | House to mark up foreign intel reform law | FBI can't access Texas shooter's phone | Sessions to testify at hearing amid Russia scrutiny FBI can’t unlock Texas shooter’s phone MORE has focused on physicians in his effort to solve the over prescribing problem, and he has targeted the ones who prescribe the most pain medications. This approach suggests that the volume of prescribing is the problem according to the Department of Justice.

The Centers for Medicare & Medicaid Services (CMS) is also targeting patients who receive higher doses of opioids. The assumption is that these patients are abusing the medication, so they are forcing physicians to reduce or eliminate prescriptions. This approach assumes administrators can determine whether the medication is appropriate simply based on dose and that "one size fits all" with pain patients.

The unintended consequence of today's version of the "war on drugs" is that people in pain have been forgotten. It is as if they don't exist, or that they have fabricated or exaggerated their needs. Every time people ask for painkillers, they face accusations and judgment in place of compassionate care.

The stigma of using opioids that began almost half a century ago persists. In part, that's because people in pain who use the drugs responsibly are grouped into the same category as those who obtain the drugs illegally and abuse them.

The availability of too many opioids, many of which have been diverted or adulterated, is a problem. However, the solution to the opioid crisis is not to force people in pain to suffer more.

There is a better way to address the problem.  In 2016, Congress passed the 21st Century Cures Act (Cures) which authorizes 4.8 billion dollars for the “discovery, development and delivery of new treatments and cures.”

Since chronic pain affects more people than diabetes, cancer, and heart disease combined, Congress should appropriate a substantial portion of the CURES funds for pain research and the discovery of safer pain medications.

If pain medications with lower likelihood for addiction are developed, there would be fewer opioids prescribed. It would happen organically, and it wouldn’t require the involvement of the Department of Justice, CMS, or any other agency to force arbitrary reductions in opioids prescribed that currently leave many people in pain suffering needlessly.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis has eight draft recommendations for addressing the opioid crisis. None of the recommendations include the need to discover, develop, and deliver new, safer, and more effective pain medication. That is a missed opportunity that could result in the deaths of thousands of Americans who cannot find relief for their chronic pain except from the street.

Finding a solution to the opioid crisis is possible, but it will take Congress to act, not law enforcement to penalize. The long-term solution to the opioid crisis is to replace opioids as we know them today with non-addictive, yet equally effective, medication.

Lynn R. Webster, M.D. is Vice President Scientific Affairs for PRA Health Sciences. He is a past President of the American Academy of Pain Medicine. In addition, he is a co-producer of the public television, “The Painful Truth.” Visit him online at www.thepainfultruthdocumentary.com. You can find him on Twitter: @LynnRWebsterMD