Commentary: Balancing Benefits and Risks: Opioid Pain Medication

Opioid pain relievers are the most widely misused and abused controlled prescription drugs and are involved in most unintentional poisoning deaths.[i] Such deaths have quadrupled since 1999, and by 2007 outnumbered those involving heroin and cocaine.[ii] In 2011, nearly 17,000 drug-poisoning deaths in the U.S. involved these medications.[iii]

These facts are not new, and have circulated widely throughout the media in recent months. Deaths of celebrities like Phillip Seymour Hoffman and others have brought new awareness to the dangers associated with prescribed potent extended-release and long-acting opioids. The overdose deaths may be all too intimately known to you as well, with some 34 million Americans 12 years of age or older reporting having used an opioid for non-medical usage at some time in their lives[iv] and 1 in 20 high school seniors reporting having abused OxyContin.[v]

But the prescription overdose epidemic represents only a symptom of a larger underlying condition that is slowly and tragically being brought to public consciousness. In addressing overdoses, clinicians and the public have largely focused on how to safely prescribe opioid medication and on limiting access to opioid medication. These are important steps in solving the problem, but more needs to be done to address the underlying issue: addiction.

Addiction is a chronic and treatable disease that is present in approximately 10 percent of the population. [vi] Opioid overdose deaths frequently occur in people with untreated addiction and recently, in my practice I’ve seen a shift in deaths from prescribed opioids to heroin. The media is starting to report the increase in heroin use, but is failing to discuss treatment. The good news is addiction, and in particular addiction associated with opioids, is a treatable disorder.

Health care providers can help reduce overdose deaths by acquiring the skills to recognize the signs of addiction and helping patients access treatment; in other words, the help of every health care professional is needed to diagnose and refer patients with the disease of addiction to treatment. The American Society of Addiction Medicine (ASAM) has a wealth of resources on www.ASAM.org that can help health care workers identify, manage and treat addiction.

Clinicians who are prescribing extended release and long-acting opioids can obtain education to learn skills necessary for the safe and effective prescribing of opioid medication. ASAM hosts a free three-hour continuing medical education credit course  as part of a collaboration called “CO*RE” between nine other medical and health care organizations. This course is part of a program established by the Food and Drug Administration to support risk evaluation and mitigation strategies when prescribing extended release and long-acting opioids.

Patients and families can also take steps in their own homes to curb opioid misuse. In particular, parents and grandparents of teens and young adults should always be aware of the medications that are in their home. Safe storage of all prescription medications is extremely important when there are toddlers and young children in the home, and medications should be stored in locked boxes instead of the bathroom medicine cabinet. Parents should also talk to the parents of their teens’ friends to ensure that their medications are being safely stored. If opioids are being prescribed, naloxone overdose prevention kits should be discussed with the health care provider and be available  in the home to reverse the effects of an accidental overdose.

Opioid use disorder (opioid addiction), although a serious problem, is treatable. There are a variety of medications available to treat opioid use disorder as well as a variety of psychosocial treatments which should be used in a complimentary fashion. If you know someone who you suspect may be suffering from an opioid use disorder urge them to seek help. In short, treat addiction and save lives.

Edwin A. Salsitz, MD, FASAM

[i] U.S. Department of Justice: National Drug Intelligence Center. National Drug Threat Assessment. Johnstown, PA: National Drug Intelligence Center; 2011. http://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf. Accessed August 29, 2014.

[ii] Department of Health and Human Services: National Institutes of Health: National Institute on Drug Abuse. Prescription Drugs: Abuse and Addiction. National Institute on Drug Abuse. Published July 2001. Revised October 2011. Accessed August 29, 2014.

[iii] Centers for Disease Control and Prevention. Home & Recreational Safety: Prescription Drug Overdose in the United States: Fact Sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. Published July 3, 2014. Accessed August 29, 2014.

[iv] Collaborative for REMS Education (CO*RE). Tools & Resources: Curriculum Slide Deck. CO*RE. http://www.core-rems.org/tools. Published August 2013. Updated August 2014. Accessed August 29, 2014.

[v] Department of Health and Human Services: National Institutes of Health: National Institute on Drug Abuse, op. cit.

[vi] In 2013, the National Survey on Drug Use and Health (NSDUH) estimated that, within the past year, 24.6 million people 12 or older (9.4 percent of the population) live with substance dependence or abuse, based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria.” http://www.samhsa.gov/data/sites/default/files/NSDUH-SR200-RecoveryMonth-2014/NSDUH-SR200-RecoveryMonth-2014.htm