Opioid Use Skyrocketed
Many pharmacists have noticed an increase in the use of opioids over recent years. But the numbers might still surprise you.
I was reading the weekend edition of The Wall Street Journal the other day when I came across this interesting article. It describes how a pain management expert that once lobbied for the expanded use of opioids is now questioning that logic.
The pain specialist, Dr. Russell Portenoy, years ago argued that opioid pain medications weren’t as addictive or dangerous as previously thought. Now he’s apparently changed his tune.
The numbers are difficult to argue. In the United States, the use of opioid derivatives has skyrocketed in the last decade. According to the WSJ article, the amount of opioids used in the U.S. has over tripled since 2000 (from 2 kg sold per 10000 people in 2000 to 7.1 kg per 10000 in 2010).
In the same decade, opioid related deaths went up over four fold while admissions for opioid addiction treatment was up over five fold. All this happened as doctors began prescribing these medications for all sorts of chronic and acute pain.
The WSJ reports that opioid overdoses are responsible for more deaths in the U.S. than all illegal drugs combined. Thousands of people die each year as a direct result of an overdose. Are these deaths a result of opioid over-prescribing?
Dr. Portenoy now questions the widespread use of these pain relievers and cautions other prescribers to use them sparingly. The addiction potential is seemingly much greater that prescribers were aware of years ago.
The dilemma becomes how do you treat chronic pain suffers effectively while still minimizing the risk of abuse? Some patients can effectively manage a long term opioid pain regimen without falling into the addiction trap. But practitioners don’t have a reliable means to identify who is at risk for abuse and who is not before starting patients on opioid therapy.
I think modern medicine needs to learn more about the process of abuse and who falls into the addiction cycle. Learning key facts like what causes some patients to become addicted might answer questions like how do you use drugs effectively without creating more abuse.
I also think our drug abuse culture is an indictment on our inadequate metal health treatment in the United States. I would argue that a significant percentage of our drug abuse problem is rooted in untreated or under-treated mental health issues.
Tackling those mental health problems, understanding the addiction process with opioids, and developing newer pain relievers with less addiction potential are the keys to effective pain treatment going forward. But first the medical community must address the abuse potential of opioids and realize that their widespread use does come with severe consequences.
The WSJ article was very telling. You have a physician who once was on the forefront of expanding the use of opioids now questioning that decision. If a pain management expert can question opioid use and argue that their risks are being overlooked, we should all stop and pay attention.
I’m not saying chronic pain patients should needlessly suffer if there are effective treatment options available. What I’m arguing is that we are now facing an epidemic of abuse that will not resolve itself without some serious changes to how modern medicine treats pain.
It’s time for all of us to open our eyes to what opioids really are and use these drugs appropriately. It’s also time for a serious look at drug addiction and it’s root causes so we can identify at risk patients.
Opioids are not bad drugs if they are used properly. But extending their use to a large percentage of pain patients does have negative consequences.
I think it’s time we really look at how we’re using these medications for pain management. I’m just afraid that if we do we won’t like what we find.
The Redheaded Pharmacist
Tags: general topics, Healthcare, In the news, pharmacist
Drugs, General Topics, Healthcare, In the news | The Redheaded Pharmacist December 17, 2012
4 Comments to “Opioid Use Skyrocketed”
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By pharmacy chick, December 17, 2012 @ 6:35 pm
ive been yakking about this for years. Not only pain meds but C2′s in general. over use, overprescribing on a grand scale. You can’t walk out of an urgent care without some narcotic it seems. Forget the NSAIDS, lets even forego the T-3…go straight to the oxycodone. its ridiculous actually. ANd what of the ADD meds? has this generation become kids that need meds to study, pay attention, function? We are a disturbed nation, to be sure.
pharmacy chick(Quote)
By PharmacistORtortureslave, December 17, 2012 @ 7:26 pm
Some True facts about being a RETAIL pharmacist (ie/ the introductory and available jobs for pharmacists/ also usually ‘easier’ jobs to get). This is not a rant just some honest truths from my experience:
1. You are a company employee; not a health professional or a ‘doctor’ (as viewed by other medical professionals, your boss including even your store manager, and patients (…I mean ‘customers’).
2. You are a ‘bag boy’ (“the velveeta rang up the wrong price!!”… ” how much are these paper clips?”.
3. You are a ‘phone rep’ (“do you have ‘oxy’ in stock”?… “i want to call in 10 subscriptions”… “prescription numbers 12345, 12346, 12347, fill these now i’m on my way”)
4. You are a ‘product location assistant’ (‘where is the milk?’…’Show me where it is!’… ‘is it on sale?’)
5. You slave for the federal government and other banking institutions where you took out loans from ( most students graduate with $100,000+ in student loans). You have to pay this back with after tax dollars.
6. Potty breaks… NO! Hold it for at least 8 hours. If you need to go then bring a catheter and bag with you. ( As a ‘Professional’ you are exempt from laws requiring lunches and breaks in most areas of the country). I know pharmacists who have urinated or defecated in their pants by ‘accident’ due to lines of people not letting them go to the restroom.
7. Lunch Breaks… NO! (see #6)
8. Anyone… I repeat ANYONE… can come to the counter requesting your attention ( The general public). Perhaps some pharmacists can post stories on this?
9. You are usually ‘salaried’. You are paid for 40 hours (depending on position) but if you have to stay ‘extra’ because it is a busy day or your technician is out sick you are working for ‘Free’.
10. Oh, you are a ‘drivethru window assistant’… at the same time as #1,#2,#3,#3,#3,#4 (I was not unintentionally stuttering when I typed #3,#3,#3). (If your pharmacy does not have drive-thru then LUCKY YOU!)
BE WELL
PharmacistORtortureslave(Quote)
By The Redheaded Pharmacist, December 17, 2012 @ 10:57 pm
(The following comment was written by a reader. My spam filter blocked it by mistake so I agreed to post it for them. If anyone ever has a problem posting legitimate non-spam comments on my site please e-mail me and I will gladly post your comments for you.)
From Pharmaciststeve (www.pharmaciststeve.com):
The reality of it all is that stats are misrepresented to help the DEA justify it existence and increased budgets
All healthcare professionals need to know if the person in front of us is who they say they are … here is just one example Spam bot won’t let me post link.. if you want to read it.. send me a email
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76 charges of ID fraud, 76 charges of forged Rxs and 40 counts of insurance fraud. This is just ONE PERSON that got caught.
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Joint Commission made pain management a FIFTH vital element in 2000-2001 and made it a MAJOR STANDARDS for hospitals and other entities that they credentials… the 2000-2010 was declared at the “decade of pain management”
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It is estimated that -at any given point in time – 20% of the population is borderline alcoholics. Is this 20% having some undiagnosed/untreated mental health issues… IMO .. most likely
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Here is one of my blog posting from Feb,2011 on a study that indicates that the increased deaths by drugs are largely SUICIDES … but reported as ACCIDENTAL. Spam bot won’t let me post more than one link .. got to page 17 on my blog
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How much increase funding do you think that the DEA would get .. if they went to Congress and admitted that >50% of the people they are going after.. are really mental health pts that are committing suicide?
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If you notice… it is typically reported that a death by drugs is stated that toxicology confirmed that it was a ACCIDENTAL OVERDOSE.. I may not be the brightest bulb in the box in regards to toxicology… but how in hell does toxicology determine that a death by a drug overdose is ACCIDENTAL ?
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Healthcare professionals need to be able to validate the ID presented against the state’s database.. if the person in front of you is not the name, DOB, pic on the driver’s license.. should you be providing a controlled substance to?
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I also posted this past June ,2012 IF I WAS A DRUG DIVERTER go to page 1258 on my blog
how I would scam the system and be very hard to catch with the system that we now have in place.
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IMO… we don’t have a drug abuse problem in this country.. we have a mental health crisis that is the underlying contributing factor to the drug abuse that we see.
The Redheaded Pharmacist(Quote)
By The Redheaded Pharmacist, December 20, 2012 @ 11:51 pm
(The following comment was written by a reader. My spam filter blocked it by mistake so I agreed to post it for them. If anyone ever has a problem posting legitimate non-spam comments on my site please e-mail me and I will gladly post your comments for you.)
From LDPlaceboeffect:
“IMO when ascertaining a level of pain was made a fifth vital sign in hospitals, the answer should not have been a call for immediate use of opioids. Pain is caused by a number of different etiologies. And, there are even a number of non-drug modalities effective for relief of pain depending on the cause(s). Pain relief using solely opioids in a way is like the old-time use of barbiturates for sleep, yes, the barbiturate drug class ‘puts one out’ but uses buckshot to hit a target.
It is also my opinion, Steve, that “IMO… we don’t have a drug abuse problem in this country.. we have a mental health crisis that is the underlying contributing factor to the drug abuse that we see.” and which opioids might be the ineffective and dangerous shortcut.
The AMA Drug Evaluation edition in early ’80s when I was in pharmacy school was published comparing propoxyphene to moderate doses of aspirin for relief of pain, and recommending limiting well-nourished adult doses of acetaminophen to no more than 4 grams/day for those with adequate liver function and no underlying liver disease. Yet, when I graduated and began practicing as a pharmacist, I saw complete disregard for this. Darvocet was one of the most popularly prescribed drugs up until the last five years when it was actually NO longer available.
My mother has a number of allergies, limitations to use of NSAIDs due to chronic anticoagulation, and a lot of peripheral vascular pain and neuropathy for which she was limited to use of the only thing she said she could take, propoxyphene. Knowing what I knew, I asked her if the Darvocet actually helped with the pain relief. She said, ‘not really ‘ and it made her feel nauseated but ‘was something’.
I mentioned n-apap in the example because pharmacy students have it pounded in their collective brains about limits on its intake, and yet one of the most common causes of liver failure continued to be high intake of it– some accidental, some deliberate.
The point here, though is not to place ‘blame’ on any single entity, but as Hillary Clinton’s book’s title suggests … it takes an entire ‘village’ of education, laws, support, and common-senses to build consensus. Although I would not want to see a chiropractor validly earn as much money as I do, in government payment or ‘health insurer’ remuneration because of the ‘placebo quackery’ effect of faith-healers, naturopaths, homeopaths, and chiropractors, much of the benefit of medicine might be ‘hands on’ for which highly trained physicians (and pharmacists) might not have the wherewithal for fee reimbursement.”
The Redheaded Pharmacist(Quote)