Final Project

Advocacy Article: People for Responsible Prescriptions

The United States is going through the deadliest and most widespread epidemic in drug abuse and addiction in decades, and it’s all due to medical doctors overprescribing opioid painkillers, such as hydrocodone and oxycodone. Over the past 15 years, there has been a steady increase in the opioid prescriptions sold and subsequently the amount of prescription opioid-related deaths, as well as illicit opioid-related deaths.

According to the Centers for Disease Control and Prevention, the amount of opioid prescriptions sold in the U.S. has quadrupled since 1999, despite there being a complete lack of reported pain increase in the American population. Not surprisingly, the amount of prescription opioid-related deaths has quadrupled, as well. These fatalities do not even include the amount of people who pass away from illegal opioids, like heroin and black market Fentanyl.

Sadly, many of these people got their start as addicts with legally prescribed opioid painkillers. According to a BusinessInsider interview with opiate-use researcher Dr. Ted Cicero, “it has become a natural progression for many people taking opiates to move to heroin over a period of time” due to its accessibility and lower prices in comparison to prescription pills. This claim is thoroughly backed up. For example, the CDC states that people who are addicted to opioid painkillers are 40 times more likely to become addicted to heroin.

To add, scores and scores of heroin addicts outwardly claim they got their start with opioid prescriptions from their doctors. In the following Al Jazeera America clip (7:28-8:45), a man using heroin for over half his life describes how his addiction, and that of many others, started with prescription Vicodin and Oxycontin. Following his testimonial, a group of recovering heroin addicts all describe their very similar beginnings to addiction.

Why is this happening, and what can we do to prevent more opioid abuse and opioid-related deaths?

First and foremost, doctors are prescribing more opioid painkillers than ever, as shown in the CDC statistics. The reason for this is the increasing leniency in the medical field toward these powerful painkillers. Prior to the early 1990’s, doctors were hesitant to prescribe opioids due to their fear of creating addicts. However, everything changed with the advocacy of pharmaceutical companies, specifically with the introduction of Oxycontin.

In the same BusinessInsider interview, Cicero said that “there was a big push [by pharmaceutical companies] saying [doctors] had a big problem with the undertreatment of pain,” and that they should start attending to it as an important vital sign. An easy fix to this was opioid pain relievers, due to their astonishing effectiveness. Doctors and pharmaceutical companies did not anticipate the even more astonishing backlash of opioid prescription advocacy.

Previously, doctors feared opioids’ tendency to create user dependency, but the Oxycontin campaign brought forth the idea that no one should have to suffer in day-to-day pain. Whereas beforehand, the strong opioid painkillers were reserved for more extreme cases, like cancer patients, Oxycontin normalized the idea of chronic pain patients using them, as well. This kind of pain can be anything from migraines to lower back pains to bad knees, etc.

Not to much surprise, but this opioid advocacy certainly seems to be motivated by profit on behalf of both pharmaceutical companies and doctors. As John Oliver put so elegantly:

“A nuanced discussion between the medical community about the complexities of pain treatment is clearly important. The problem is that discussion became dominated by the pharmaceutical industry, who started amplifying the message that opioids should not just be used for acute pain, like that from cancer or surgery, but for all sorts of pain, like arthritis and backaches, which makes sense as a motive coming from the pharma industry. End-of-life pain care is a narrow business. It’s hard to make a lot of money off a product exclusively marketed to people who are close to death.”

With the idea of profit motivation in mind, doctors can easily make more money by prescribing name brand opioids like Oxycontin as painkillers over using other, safer painkillers and pain management methods. According to a ProPublica analysis discussed in an NPR article, “doctors who got money from drug and device makers prescribed a higher percentage of brand-name drugs overall than doctors who didn’t.”

How does this connect to the opioid epidemic? Money is a huge incentive for doctors are prescribing opioids at an alarming rate. For example, In Florida, 84.8% of doctors received payment from a drug company in 2014. This statistic, although not the highest in the U.S., is mirrored in Florida’s appalling amount of “pain clinics” and in opioid addiction rates and deaths.

So, in a country where the extremely important issue of pain treatment is in the hands of profit-hungry pharmaceutical companies, what can be done for struggling opioid addicts and the future of this devastating epidemic? Our doctors, our caretakers in health and livelihood, need to take responsibility for what they started.

The catastrophe that began with the overprescription of opioid painkillers can indeed be alleviated in one obvious way: stop haphazardly prescribing opioids. They may mitigate a patient’s pain, but they also put them at huge risk for life-ruining or even life-ending opioid addiction. While opioids are extremely important in many cases of pain management, doctors can prescribe smaller doses and a shorter supply to prevent patients from becoming addicted. The CDC calls this practice “start low and go slow.”

Another way doctors can make a difference in the opioid epidemic is by using non-opioid pain management methods. There are numerous approaches to pain treatment that do not have to include opioids. The CDC suggests non-pharmacological therapies like exercise and cognitive behavioral therapy, as well as non-opioid pharmacological therapies, such as anti-inflammatory medication.

In addition, the use of complementary therapy is helpful. This can include small doses of opioids in conjunction with any of the above non-opioid pain relievers, which can even include physical therapies, herbal remedies, and attention to an anti-inflammatory diet.

Even more pain management methods are being used and researched with the realization of the opioid epidemic’s awful impact. For example, Dr. Daniel Burkhead is turning to spinal injection therapies that treat the pain at the source, rather than simply temporarily alleviating it with prescription opioids.

The brunt of doctors’ overprescribing of opioids has not gone unnoticed. President Obama has addressed it with his efforts in opioid-related legislation and awareness, and Surgeon General Vivek H. Murphy has launched the TurnTheTideRx campaign to ask doctors to pledge their responsible management of patient pain.

I am advocating the same position with #PeopleforResponsiblePrescriptions. With doctors at the forefront of the country’s health, their guidance is taken extremely seriously. Their responsibility is not only to manage patient pain, but also to take the risk of addiction into crucial consideration. Before profit comes the patient.

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