Pubdate: Mon, 19 Mar 2018
Source: Daily Herald (Arlington Heights, IL)
Copyright: 2018 The Daily Herald Company
Author: William Robb


Historically opioid medications were used cautiously by physicians for
selected patients to reduce pain associated with acute injury or
illness, and for those suffering from life-threatening diseases such
as cancer.

This caution was based upon recognition that improper use of opioids
could result in patient harm. However, in 1996, the American Pain
Society, supported by opioid pharmaceutical manufacturers, promoted
acknowledgment and expanded treatment of pain as the 'fifth vital
sign" by physicians in hospitals. In 2001, the Joint Commission on
Accreditation of Healthcare Organizations introduced new pain
standards recognizing the under-assessment and treatment of pain,
which then expanded the use of opioids. In the two decades that
followed opioid use and abuse has exploded, with nearly 80 percent of
the world's opioid medications now being consumed in the U.S.

Between 2012 and 2017, opioid pharma manufacturers gave millions of
dollars to nonprofit patient advocacy groups supporting increased
patient access to opioid medications. During this same period pharma
spent millions of dollars on marketing to doctors, encouraging --
expanded pain treatment and opioid use for patients. This occurred
despite a growing recognition that by 2015 opioid misuse and abuse was

Today, an estimated $78.4 billion dollars is being spent annually for
medical treatment, lost productivity and the added health insurance
and criminal justice costs of opioid abuse and dependency. Every day
in the U.S. between 50 and 100 Americans die from opioid overdoses.
Recent celebrity deaths illustrate the increased misuse of new
powerful synthetic opioid medications, such as Fentanyl (100 times
more potent than morphine). Deaths from these new opioids designed to
be used only in monitored health care settings are more than doubling
every year.

This uniquely American epidemic must be ended. Required will be new
public policies, expanded regulation and a return to the historical
values of physicians to above all "do no harm."

All opioid prescriptions need be carefully managed by physicians and
their staffs including: dosing for days not weeks, use minimum
effective dosages, use of least harmful and powerful medications, use
for a minimum treatment duration and prescribing the minimum total
pill amount based upon expected pain to reduce unused medication
risks. Use of the more powerful or extended-release opioids should
primarily be limited to specific painful conditions for which opioid
therapy has been demonstrated to be safe and effective or life ending
conditions that are fatal, such as cancer.

Also by all health care providers prescribing opioids is expanded use
of state supported controlled substance databases to increase
monitoring of opioid use and abuse among their patients. Databases
alone, however, cannot solve this epidemic.

Needed also will be increased oversight of the opioid pharma industry
to more carefully regulate opioid marketing, distribution and
consumption. A recent announcement by Purdue Pharma -- maker of
OxyContin -- indicated that it has reduced its physician marketing
sales staff by more than 50 percent. This may indicate increasing
pressures on the Pharma industry from a deluge of lawsuits claiming
harm to thousands of patients from misleading marketing information
and inadequate addictive risk disclosure.

Strong leadership will be needed among physicians and within the
medical community to change public opinions regarding treatments for
pain and reduce opioid consumption to end this horrible deadly epidemic.

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Dr. William J. Robb III is orthopedic director, chief medical officer at 
Illinois Bone & Joint Institute.
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