In the US, 130 people die every day from opioids alone. Since 1999, the country has seen three separate waves of opioid overdose deaths that have killed more than 700,000 people. It’s difficult to understand how one epidemic in our nation could kill nearly three-quarters of a million people. However, it has. We can no longer stand by and let it continue, and we must do all we can to help stop the opioid epidemic.
Physicians are on the front lines of care and as such, play a significant role in saving lives. The opioid problem is so complex – and so vast – that there is no one perfect strategy to combat it. It truly is an all hands-on deck situation, using every method that will work in every corner of the country to reduce opioid use and deaths. Here are some of the approaches being adopted.
Advocating & promoting non-opioid pain treatments
Hospitals and physicians are now acutely aware of the importance of educating patients about the effectiveness of non-opioid pain treatments. Patient education materials are focusing on alternatives to opioids, ranging from ibuprofen and acetaminophen to yoga and massage. Others encourage patients to engage in regular physical therapy to reduce pain.
The change in this area is that providers are now discussing pain management proactively to make patients aware that the first line painkiller will no longer be an opioid. Rather, they will be prescribed judiciously and only as a second or third line of response to pain.
Doctors Can Follow the AMA Six Steps
The American Medical Association’s Opioid Task Force has identified six recommendations for physicians who want to actively help stop the opioid epidemic. They are:
- Register for and use your state Prescription Drug Monitoring Program to make more informed prescribing decisions
- Ensure you have the education and training on effective, evidence-based treatment
- Support and advocate for comprehensive care for patients in pain and those with a substance use disorder
- Reduce or remove the stigma of substance use disorder and increase access to treatment
- Increase access to naloxone to save lives from overdose and supporting broader protections including co-prescribing
- Work with your patients to promote safe storage and disposal of opioids and all medications
Make Naloxone Available
The AMA Opioid Task Force has taken a straightforward stance saying, “naloxone saves lives”. It encourages physicians to be trained in medication-assisted treatments. Its fact sheet on opioids encourages physicians to “consider co-prescribing naloxone when it is clinically appropriate to do so.” This is a decision to be made primarily between the patient and physician. Though co-prescribing naloxone is not a guarantee for an overdose reversal, it does provide a tangible option for care that otherwise may not be available in a timely manner. In addition:
- Co-prescribing naloxone has been found to reduce emergency department visits and may help patients become more aware of the potential hazards of opioid misuse. Patients often find the offer of a naloxone prescription acceptable.
- Primary care providers have found co-prescribing naloxone to be acceptable.
- Co-prescribing naloxone does not increase liability risk.
This stand by the AMA has led some public health directors at the state level to consider writing standing orders for naloxone. This would make it available from a pharmacist without a specific prescription for a specific patient.
The fact that all 50 states have naloxone access laws makes accomplishing that goal easy.
Treat patients with other medications
Yale is promoting the use of methadone and buprenorphine to combat the underlying cravings caused by opioid use. An article in Yale Medicine Magazine says “more than 90% of those who go through detoxification and attempt abstinence will relapse within six months. Opioids rewire the brain, causing intense cravings often impossible to resist.” Medication-based therapy keeps people in treatment while “decreasing cravings, withdrawal, criminal activity, and death. Individuals can work, maintain interpersonal relationships, and lead productive lives.”
Enlist care management and a team-based approach to care to improve patient adherence
The rate of opioid-caused deaths is not slowing, in direct relation to the slowdown of prescribing. Patient adherence to new treatments may be one reason, the brain’s rewiring caused by opioids maybe another. Case management and a team-based approach to care may be able to make a difference because they can:
- Educate patients on medication-therapy compliance
- Make use of drug monitoring programs to improve patient outcomes
- Screen patients for risk factors
- Coordinate urine drug testing
- Support physicians with data on patients and history of controlled substances
It’s now a cliché to say “It takes a village,” but this line remains true regarding the opioid crisis. Physicians can reduce prescribing, introduce medication therapy, and educate patients, but they need support. Patients need comprehensive, sustainable support to make it through the addiction to the other side. Antiquated beliefs about naloxone and other types of medication-therapy need to be discarded. However, together we are in a position to make a difference to stop the opioid epidemic and reduce the number of deaths caused by this nightmare drug.
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