By Robert G. Bell
America, are we in need of an intervention?
Since 2000, the rate of deaths in the United States from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioid pain relievers and heroin: More people died from drug overdoses in the United States in 2014 than during any previous year on record. In 2014, there were 47,055 drug overdose deaths in the United States, a 6.5% increase from 2013. The most commonly prescribed opioid pain relievers such as oxycodone and hydrocodone continue to be involved in more overdose deaths than any other opioid type, and those deaths increased by 9% in 2014 to 28,647 deaths, or 61% of all drug overdose deaths. The rate of opioid overdoses has tripled since 2000, and the data suggest this epidemic is caused by an increase over the past 15 years of prescribing opioid pain relievers (and an increase in overdose deaths) and a recent surge in illicit opioid overdose deaths, driven largely by heroin.
The recent documentary Prescription Thugs highlights that the most abused prescription drugs are painkillers, tranquilizers, and stimulants. In 2012, 259 million prescriptions were written for opioids, enough to give every adult American their own bottle of pain medication. And pain management medications are big business. According to Prescription Thugs, the pharmaceutical industry made $711 billion producing drugs to treat symptoms and manage medical conditions. In addition, the pharmaceutical industry spent approximately $422,000 per U.S. congressman to lobby their causes. The film implies that the pharmaceutical industry profits from the symptoms and not the cure, which we will discuss in a future post.
And speaking of Congress, last month the U.S. Senate Committee on the Judiciary agreed that the epidemic of heroin and prescription drug abuse needs to be tackled immediately, but there was disagreement over the problem’s root causes, which ranged from border control to heroin market forces to overprescribing. Although no consensus could be reached regarding the key causes of the heroin and prescription drug abuse epidemic (are we surprised?), the committee showed support for the Comprehensive Addiction and Recovery Act (CARA), the primary piece of legislation presented at the hearing. This legislation’s core elements are opioid abuse and prevention education efforts, expanding the availability of the opioid antagonist naloxone hydrochloride (Narcan) to first responders and law enforcement, expanding drug take-back efforts, strengthening prescription monitoring drug programs, and creating prescription opioid and heroin treatment intervention programs.
But what is our problem? Although we make up just about 5% of the world’s population, we consume more than 75% of the world’s prescription drugs. Do we need a pill for everything and anything that ails us?
Everyone has pain, whether it be acute or chronic, and it is an individual struggle. The key is management of the pain through various regimens that may include combinations of ice and heat, exercise, physical therapy, acupuncture, meditation, and biofeedback as well as pharmacotherapies with analgesics (e.g., NSAIDs, etc.), anticonvulsants (e.g., gabapentin), antidepressants (e.g., amitriptyline), and nerve-blocking agents (e.g., mepivacaine, steroids).
Although I don’t favor of substituting one abusable compound for another, medicinal marijuana may provide an alternative pharmacotherapy for pain management. As stated in a previous post, there is good scientific evidence for marijuana’s use in the treatment of chronic pain (and multiple sclerosis). Additionally, marijuana has a very good safety profile (low toxicity) in humans and there has been no documented evidence of death exclusively attributable to cannabis overdose to date. Perhaps medicinal marijuana should play a bigger role in today’s pain management: It is effective in reducing pain with a much better safety profile than the opioids.
So, yes, America, we are in need of an intervention, not only on opioid dependence but on prescription drug dependence. The safe prescribing of all medications, including prescription opioids, should be reinforced and patient-physician follow up encouraged. The continued development of abuse resistant formulations should be encouraged. Naltrexone should be routinely coprescribed or available with any opioid prescription. Integrative pain management plans that includes physical and emotional as well as pharmacologic therapies should routinely be offered to patients. Drug abuse awareness and prevention education should be provided to all, especially the young. This month, the White House proposed $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic, and the FDA announced plans to review and revise the agency’s opioid approval process and policies.
So intervene away and let’s put pain and addiction in its place.