How the US Opioid Epidemic Puts Pain Patients At Risk – and How the UK’s NHS Is Doing Things Right
A crackdown on opioid prescriptions is leaving many patients with chronic and acute pain to suffer with no help at hand.
In the 1990s, medical professionals began to prescribe prescription opioid pain relievers at a disproportionate rate after unscrupulous pharmaceutical companies assured them that the drugs were not habit-forming. Unfortunately, before it became clear that these medications were highly addictive, misuse and addiction had run rampant. Many of the patients who misused opioids and developed an opioid use disorder eventually transitioned to heroin.
In the United States, opioid and heroin use has reached epidemic proportions.
Every day, more than 115 Americans die after overdosing on opioids. Addiction to and misuse of prescription opiates, heroin, and fentanyl has become full-blown a public health crisis — one that has had devastating consequences. Not only have overdoses increased, there’s been a rise in neonatal abstinence syndrome due to opioid misuse during pregnancy and an increase in the spread of infectious diseases (such as HIV and hepatitis C) due to injection drug use.
A surge in opioid prescriptions has also been seen in the U.K. In 2017, English GPs prescribed 23.8 million opioid-based painkillers — a growth of 10 million prescriptions in only a decade. In 2016, there were more than 2,000 deaths in England due to opioid overdose, the highest since records were created. However, unlike deaths in the U.S., these overdoses were largely related to heroin rather than prescription opiates.
To stem the tide of deaths, U.S. officials from the Centers for Disease Control and Prevention (CDC) released a set of guidelines for doctors on how to prescribe opiates for the treatment of chronic pain. Although the CDC’s guidelines were only supposed to be recommendations, many states turned them into laws that limited physicians’ ability to provide opioids in high doses and for more than a few days at a time. At the same time, health insurance companies, pharmacy benefit managers, and pharmacies themselves enacted their own restrictions.
Unfortunately, these laws and restrictions had horrible consequences.
Patients are suffering because of the crackdown on prescription opiates.
Since the passage of these laws, doctors have been pressured to lower doses — even for model patients who have been on fixed doses of opiate pain relievers for years. This has led to many practitioners reducing opioid medications from a legal and regulatory perspective rather than a clinical one. Fear of investigation is clouding their judgement, and their patients are suffering for it.
A recent survey conducted by the SERMO physicians social network found that over half of doctors surveyed reported decreasing opiate prescriptions within the past two years. However, 36 percent of those doctors believed that patients had been harmed by these prescription reductions.
Indeed, patients have been harmed by the blanket opiate laws. Many chronic pain patients in the U.S. have a legitimate need for opioids, and the impact of these new guidelines has been serious. Some patients who have had their opioid prescriptions reduced or cut off have turned to heroin and other street drugs to self-medicate, greatly increasing the risk of accidental overdose. Even worse, according to a survey by the National Fibromyalgia and Chronic Pain Association, 38 percent of chronic pain patients reported considering suicide. Sadly, too many have gone through with it.
Cutting back on prescription opiates for those in pain is not the answer.
Cutting back on prescription opiates for both chronic and acute pain patients is doing far more harm than good. So what kinds of solutions could help? Firstly, doctors could encourage the use of non-narcotic medications and non-pharmacologic treatments. This includes medications such as ibuprofen, exercise such as yoga, and treatments such as physical therapy, nerve blocks, massage, or cognitive behavioral therapy. That said, many Americans simply cannot afford these alternative treatments as they’re not covered by health insurance.
Those who are addicted to opiates and need treatment face the same hurdles. Even though most addiction treatments are covered under health insurance, they are still cost prohibitive, especially for those who have lower incomes.
What’s needed is a massive government investment and a central restructuring of how addiction is treated in the U.S. Congress needs to authorize long-term funding of addiction treatment and ensure that addiction specialists are actively linked to primary care practices, community-based addiction treatment and recovery services, and inpatient detoxification and residential treatment.
The UK’s NHS model of registering with a GP and financially covering alternative treatments and addiction treatment/recovery is a better long-term plan.
Better yet, the powers that be should look to the U.K. for a model that has been proven to work. There are many reasons why the U.K. has been protected from the opioid epidemic, and nearly all of them have to do with the National Health Service (NHS). Firstly, doctors in the U.K. work under stringent prescription oversight — patients have to register with a GP practice to acquire a prescription through the NHS. Any doctor seen to be prescribing excessively is thoroughly investigated. Registration with a GP practice also prevents doctor shopping — the practice of visiting multiple physicians to obtain multiple prescriptions. Finally, and perhaps most importantly, alternative treatments as well as addiction treatment and recovery is fully covered by the NHS — patients don’t go bankrupt trying to get well.
The Future of Addiction Treatment
Through the use of MRIs, medical researchers have discovered that there may be key differences between the brains of people who relapse repeatedly during drug treatment and those who achieve permanent sobriety. These studies indicate that people who tend to relapse may have elevated activity in the areas of the brain that respond to pleasure elicited by drugs, as well as lower activity in the parts of the brain associated with other forms of pleasure.
Not only are the results of these studies fascinating, they’re also medically significant as they suggest that, in the future, we may be able to use neuroimaging as a diagnostic tool at the beginning of drug treatment plan and increase the likelihood of success. Imagine being able to non-invasively examine the brains of people who have been tormented by addiction and determine exactly what’s needed to help them get back on their feet.
Barry Southers, a professor at the University of Cincinnati Blue Ash, explains, “It’s crucial that researchers continue to use neuroimaging to study brain function and the impact of drug use, both after immediate consumption and after prolonged and repeated use. With the benefit of accumulated research we may be able to customize treatments to meet the needs of individual patients depending on their likelihood of staying abstinent.”
There’s no magic wand. But policies like cost-free access can help.
There is no magic wand we can wave that will solve the opioid epidemic overnight, but there are a number of policies that could be enacted to help: cost-free access to addiction treatment, financial support for alternative methods of pain-management, and policies that address the root causes of addiction (such as mental health issues and socioeconomic inequality).
Until American lawmakers do what’s necessary to actually help citizens affected by the opioid epidemic, doctors and nurses will remain at the front line. It’s up to them to renew their focus on ethical prescribing, do what they can to help those who are suffering from addiction, and make sure chronic pain patients don’t get caught in the crossfire.