Pubdate: Tue, 30 Aug 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company


About half of opioid overdose deaths involve prescription drugs. With 
that stark fact in mind, the surgeon general, Dr. Vivek Murthy, sent 
an unusually direct plea last week to 2.3 million doctors and other 
health care workers to help fight the opioid epidemic by treating 
pain "safely and effectively." A website for his "Turn the Tide" 
campaign highlights alternative, nonaddictive treatments for pain. 
Not only doctors but also policy makers, insurance companies and 
other players in the health care system should pay attention.

Prescriptions for opioids such as oxycodone and methadone have 
quadrupled since 1999, as have opioid overdose deaths - more than 
28,000 in 2014, up 14 percent from the year before. While 
prescriptions for opioids peaked in 2012, their use remains high by 
historical standards. And many people who were prescribed opioids 
have gone on to use illegal opioids like heroin and fentanyl.

For cancer patients or people near the end of their lives, opioids 
are often the only effective medicine. But doctors have many more 
options for treating back pain, migraines and pain related to surgery 
- - physical therapy, anti-inflammatory drugs, acupuncture, exercise 
and so on. Some doctors overlook these alternatives because opioids 
are easy to prescribe or because patients demand them.

A further problem is that some insurance plans do not cover 
alternative treatments like physical therapy and acupuncture, or they 
impose so many limits and high co-pays on them that in many cases 
both doctors and patients find opioids a less expensive option. In 
some rural areas, the nearest physical therapist may be many miles away.

One fix here seems obvious: Federal and state lawmakers can require 
insurers to cover these services, a cheaper option over the long term 
than addiction treatment. And they should also find ways to expand 
access to health services by subsidizing doctors, therapists and 
other health care workers to make periodic visits to remote areas.

Even when opioids are necessary, doctors can minimize the risk of 
addiction by taking a few precautions. They can write prescriptions 
for low doses and relatively short time periods. They should pay 
attention to monitoring programs that most states have set up to make 
sure a person is not getting multiple prescriptions from different 
doctors. And doctors can steer to treatment patients who are 
obviously addicted.

Doctors are not the only ones responsible for the opioid epidemic, 
but as Dr. Murthy makes clear, they'll have to play a leading role in 
the fight against it.
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MAP posted-by: Jay Bergstrom