As the prescription opioid addiction crisis continues to explode, public health professionals are struggling to contain a problem that many feel has spun out of control.
According to the American Society of Addiction Medicine (ASAM), at least 50 people died of a prescription opioid overdose every day in 2014. Of the 21.5 million Americans over the age of 12 who had a substance abuse disorder that year, 1.9 million of them said they were addicted to prescription pain relievers such as methadone, oxycodone (OxyContin) and hydrocodone (Vicodin).
To offer the broad scope of the impact this has on American society: 18 Americans died in terrorist attacks on U.S. soil in 2014; another 32,675 died in automobile accidents; and over 47,000 citizens died of legal drug overdoses during the same year.
On any given day, over 1,000 Americans are treated in emergency rooms for opioid misuse. In addition to the pain inflicted on countless families and friends across the U.S., the Department of Health and Services (HHS) estimates that the annual cost of emergency room and inpatient care for opioid poisonings hovers around $20 billion. The total health and social cost, estimates HHS, is at least $55 billion a year.
The increase in opioid prescriptions over the past generation has a clear link to this addiction crisis. The U.S. Centers for Disease Control and Prevention (CDC) estimates that sales of prescription opioids quadrupled since 1999. An estimated 1 in 5 patients with pain or pain-related diagnoses unrelated to cancer contribute largely to the approximately 650,000 opioid prescriptions doled out daily across the U.S.
“What happened was that during the mid-1990s, we had a change of perspective in medicine,” said Marvin D. Seppala, M.D., chief medical officer of the Hazelden Betty Ford Foundation. “The profession became convinced that we could use these drugs safely for chronic pain, despite the evidence suggesting that was not so.”
Dr. Seppala pointed to a single paragraph in a letter to the editor published in the New England Journal of Medicine years ago, which appeared to suggest the risk of addiction from these drugs was low. Although the analysis mentioned in the letter actually did not posit such a conclusion, medical associations including the American Pain Foundation urged doctors to pay more attention to what they described as this “fifth vital sign.” The rest, they say, is history, as pharmaceutical companies began to introduce more powerful painkillers and armed themselves with a variety of dubious tactics to win doctors over.
Now that society is struggling mightily with opioids, who should take the lead and guide us out of this nightmare? Earlier this year, Dr. Sanjay Gupta of CNN insisted medical professionals must take a call to action and use far greater caution when advising their patients on pain medications.
Or should most of the burden be shouldered by drug companies? Their marketing collateral, aggressive sales representatives and success in winning over physicians arguably had a huge role in opioids’ shift from drugs rarely prescribed to a widely distributed form of treatment.
Purdue Pharma, which has been in business for 124 years, insists it is “learning from the past while focusing on the future,” and is determined to be part of the solution to alleviating this ongoing health crisis.
“While our products represent approximately 2 percent of all opioid prescriptions, we’ve led the pharmaceutical industry in developing medications with abuse-deterrent properties, which the FDA, DEA and White House consider an important part of a comprehensive approach,” a Purdue Pharma spokesperson told TriplePundit.
According to Purdue Pharma, it was the first in its industry to advocate for the use of prescription drug monitoring programs. Several years ago, the company gave the National Association Boards of Pharmacy a $1 million grant to improve the technologies monitoring interstate prescription data. As a result, the company says more than 30 states now share this data, contributing to an important part of the national strategy to combat prescription opioid abuse.
In addition, Purdue Pharma says it is committed to working with the law enforcement community in order to bolster its resources in combating this epidemic. As a complement to drug monitoring programs, the company gave $350,000 earlier this year to launch a pilot program with the National Sheriffs’ Association to provide law enforcement with Naloxone, an opioid antagonist that can prevent an overdose in the event a police officer becomes involved in such a situation. First responders, however, charge that the growing use of this drug, which is highly effective in preventing death from overdoses, has caused a spike in price.
Finally, Purdue says it supports the CDC’s guidelines covering how opioids are prescribed to treat pain. On that point, the company claims it has written to clinicians and encouraged them to become familiar with the recommendations and therefore make such prescribing decisions using far more caution.
At face value, efforts by companies such as Purdue Pharma demonstrate that the industry is taking this tragedy seriously. Nevertheless, Dr. Seppala suggests more caution, mixed with compassion, is needed if doctors -- hopefully with the support from drug companies -- are going to be smart about managing opioid prescriptions.
“We need opioids in medicine, as they can work effectively for severe pain,” Dr. Seppala said. “They are crucial for pain relief, for acute pain like a broken leg, or post-surgery. But if prescribed, they should only be taken for a few days.”
To that end, the CDC is urging doctors to recommend other treatments for chronic pain, such as non-opioid medications or physical therapy. But Dr. Seppala did not seem confident that drug companies would follow the CDC’s lead. “They are not interested in telling people that these [drugs] should generally not be used for chronic pain -- and that puts too many patients at risk,” he said.
As a result, pharmaceutical companies often conduct themselves analogously to energy companies, which sold their products for years while leaving it up to the public sector to pay for the environmental cleanup. Drug firms profited handsomely from opioids, but society at large was left to cope with the costs of healthcare emergencies and addiction treatment.
The efforts of companies such as Purdue Pharma are a positive start to helping Americans who struggle with addition and repairing the industry’s reputation. But considering that much of America is struggling with an epidemic that has become even more complicated with the emergence of more potent drugs such as fentanyl, the funding of these pilot programs so far is akin to taking a butter knife into an AK-47 fight.
Image credit: Dream Weaver/Flickr
Leon Kaye has written for TriplePundit since 2010, and became its Executive Editor in 2018. He's based in Fresno, CA, from where he happily explores California’s stellar Central Coast and the national parks in the Sierra Nevadas. He's lived in South Korea, the United Arab Emirates and Uruguay, and has traveled to over 70 countries. He's an alum of the University of Maryland, Baltimore County and the University of Southern California.