The opioid addiction epidemic that has been mounting since 2000 is finally getting serious attention.
Earlier this month, the Centers for Disease Control and Prevention (CDC) issued guidelines encouraging doctors to limit prescribing opioid painkillers.
Last week, the well-funded advocacy group Shatterproof chimed in. They are focusing on the need for national mandatory pill-tracking databases to prevent doctors from inadvertently prescribing opioids to patients who have existing prescriptions, are taking similar medications, or are taking a combination of drugs that may cause dangerous interactions.
Shatterproof is a nonprofit focused on opiate addiction. Its founder and chief executive officer is Gary Mendell, a former hotel executive whose son committed suicide in 2011 while battling opiate addiction.
Many states already require prescribing doctors to consult prescription-monitoring databases. However, in some states, only the pharmacists who dispense the drugs are required to make a note in a patient’s record.
The databases face a host of problems that disrupt their effectiveness.
For example, the Veterans Administration and active military databases don’t communicate with state databases, and the state databases don’t communicate among themselves.
That means a lot of patients slip through the cracks. Some engage in “doctor shopping” to get multiple prescriptions of drugs they abuse or sell. Others take opioids with sedatives, unaware of the increased risk of addiction and overdose.
Both addiction and overdose have become notable problems in the United States since medical views on opioids changed in the 1980s and 1990s.
A paper published in the journal Pain in 1986 concluded that opioid painkillers could safely be prescribed over the long term to treat patients with chronic pain. Ten years later, OxyContin hit the market and prescriptions skyrocketed.
Recent studies suggest that opioid painkillers, while successful in alleviating acute pain during cancer treatment or following surgery, are no better than placebos for chronic pain.
“Doctors were taught that these drugs were not harmful, that there’s no ceiling on dose, and that all patients should get these drugs if they want them, and all of those things are false,” Gary Franklin, Ph.D., one of the authors of the Shatterproof report, told Healthline.
More Pills, More Addiction
More prescriptions have helped fuel the addiction crisis.
“Overprescribing opioids — largely for chronic pain — is a key driver of America’s drug-overdose epidemic,” CDC Director Dr. Tom Frieden, M.P.H. said in a statement. “The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”
More than 4 million Americans are now addicted to prescription opioids, according to the Shatterproof report. Many who become addicted to prescribed drugs go on to use heroin, which is often cheaper and easier to get. More than 460,000 people are addicted to heroin in the United States.
Franklin calls opiate addiction “the worst man-made epidemic in modern medical history.” Since 1999, more than 200,000 people have died of overdoses.
The CDC and Shatterproof agree, in broad strokes, about what should be done.
Doctors should not prescribe opioids as a first-line treatment for patients with chronic pain.
If and when they do prescribe the drugs, they should confirm in a database that the patient doesn’t already have access to opioids.
They should limit the dose as much as possible and monitor patients carefully.
The CDC doesn’t have the authority to mandate use of pill databases in all states as Shatterproof is calling for. That recommendation has met with some resistance from doctors, Franklin said.
“Doctors really value their autonomy,” he said. “It’s not surprising that there’s resistance to the fact that there might be a mandate.”
But Shatterproof also wants to make the databases easier to use by automatically providing doctors with logins to the systems, which many states don’t do.
Shatterproof also wants to allow medical assistants to enter information on behalf of the doctor, which some states currently forbid.
The CDC directs its guidelines to the primary care providers who write nearly half of all opioid prescriptions. The agency is addressing more stringent use of opioid painkillers in cancer and end-of-life treatments.