Until we acknowledge the root of the problem, the opioid epidemic will grow

The quiet crisis hitting America’s suburbs is an unusual one, one that most on first blush wouldn’t quite believe if not dismiss. But it is in fact a very real threat and getting more deadly by the day.

The crisis is opioids, and it’s been building for years, but as with so many “crises” was never fully acknowledged or addressed over the past decade. Last week, President Trump declared, “The opioid crisis is an emergency. And I am saying officially right now: It is an emergency, it’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”

{mosads}Fifty years ago, the typical heroin addict was a poor teenage boy in the inner city. Now with the significant increase in prescription drugs that mirror heroin’s effect and addictive nature, 75 percent of the almost 3 million opioid addicts are middle class, young suburban twenty-somethings and soccer moms who started with legal prescribed narcotics, whether due to injury or recovery from surgery, or pain management, became addicted and then turned to heroin as a cheaper alternative.


In roughly the last decade, prescriptions for OxyContin, Vicodin and Percocet have tripled: in one of the more shocking statistics, in a country of 311 million people, there were 219 million opioid prescriptions written in 2011 alone.

That was the year that the Center for Disease Control first identified that a crisis was beginning: in that year, there were more deaths from opioid overdoses than car crashes. And the trend is getting worse, not better: in 2014, there were 14,000 deaths from opioid overdoses. In 2015, there were over 17,000. While 2016 numbers are not available, it is likely that deaths are only continuing to climb. How did we as a country get to this pill-to-heroin pipeline?

We’ve been deeply wrong about how we as a culture address the issue of physical pain. On the latter, consider that the Centers for Medicare and Medicaid make incentive payments to hospitals based partially on how those hospitals perform on patient satisfaction surveys that ask patients how well they feel their pain was controlled by the provider, and whether the provider did everything that they could to control the pain. The response to achieve those incentive levels has been more aggressive opioid prescriptions.

But in conversations with doctors who run emergency rooms, another problem beyond pain management surveys is how we approach the issue and diagnosis of pain. We must move towards a more appropriate response to pain and the pendulum needs to swing back towards prudence. For example, when someone walks into an ER, there is a 30-minute window used as an incentive for doctors to quickly the issue of pain.

Motrin doesn’t count in pain management, so the response is narcotics even before X-rays come back. Patients are allowed to diagnose their pain; “How is your pain on a scale of one to 10?” When the patient responds, “8 out of 10,” the response is to give narcotics, even if the patient is calmly sitting in a chair texting friends. The approach to all of this has bordered on nonchalance. In a desire to not “get dinged” on patient response forms, instead of perhaps seven days of narcotics, prescriptions are written for 10 days. Instead of five to ten pills, ten to twenty are prescribed.

So nonchalance and the government encouraging wrong behavior is fostering over-prescriptions of narcotics. In our online culture, where Amazon or Yelp reviews can make or break a book or a restaurant, government surveys have actually contributed to a national healthcare crisis. Surveys designed to save money and improve care are actually encouraging addictions that cost taxpayers tens of millions more.

Physicians don’t allow patients to self-diagnose a heart disease or diabetes, why are physicians enabling the federal government to allow patients to self-diagnose pain and to rate hospitals and doctors based off of that? The implication of overprescription, of extra pills in a bathroom cabinet or additional days of pills, are a trickle down effect that has led to this crisis point.

Until we acknowledge the root of the problem — prescription drug dependence due to pain mismanagement and role of our healthcare system and misplace government incentives — the opioids crisis will only continue to grow.

Ned Ryun is a former presidential writer for George W. Bush and the founder and CEO of American Majority. You can find him on Twitter@nedryun.

The views expressed by contributors are their own and not the views of The Hill.


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