Nov 30th 2017

Addressing the Opioid Epidemic

Opioid Epidemic: Scope and Impact

Our nation is facing one of the deadliest drug epidemics in its history. According to the Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids (including prescription opioids and heroin) has quadrupled since 1999. In 2015, there were enough opioid pills prescribed to medicate every American around the clock for 3 weeks. 

The human and financial consequences of this abuse are staggering.  An estimated 91 Americans die every day from an opioid overdose. To compound this issue, abuse of these powerful prescription painkillers costs the U.S. economy an estimated $78.5 billion a year, according to a new government study. This study, led by Curtis Florence of the CDC, found that healthcare was bearing the brunt of these costs at an estimated 30 percent—and the majority of those costs are being taken on by insurance. 

This epidemic is negatively impacting numerous stakeholders nationwide. Some recent statistics released from the CDC help paint an accurate picture:

1. In 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication. This is enough for every American adult to have their own bottle of pills. 

2. Studies have shown that approximately 25 percent of patients who are prescribed opioids for long-term pain management suffer from addiction. 

3. The link between heroin addiction and opioid addiction is a strong one. People addicted to prescription opioids are 40 times more likely to be addicted to heroin. 

4. The death rate alone is staggering: Opioids killed more than 33,000 people in 2015—more than any year on record. Nearly half of those deaths were caused by prescription painkillers alone. 

The abuse of opioids is a global issue that has negative ramifications for health, social, and economic issues throughout all societies. Unfortunately, acknowledging the issue and classifying it as an epidemic is only the first step towards a solution. It is equally as important to identify the source of this epidemic and provide an answer to the most pertinent question: Why is the cost and death rate of this addiction problem increasing at an alarming rate?

Opioid Abuse: Prescribing Patterns

One of the obvious reasons for an increase in drug-related deaths, as well as the prevalence of the disorder, is the rise in opioid prescriptions. The epidemic began in the 1990s, when doctors became aware of the increasing burdens of chronic pain. Advocacy groups then began to pressure physicians to treat patients as quickly and efficiently as possible. Complicated issues were suddenly easily treatable with these powerhouse drugs. 

Pharmaceutical companies jumped at the opportunity to market this highly effective and potent option to treat chronic pain. And chronic pain is not all that uncommon —in fact, the Institute of Medicine estimated that about 100 million U.S. adults suffer from it. While many patients and physicians now know that the risk of prescribing opioids often outweighs the benefits, alternative treatment options are sometimes deemed infeasible. 

For example, pain patients might not have insurance to cover treatments, or their health plan might not cover comprehensive pain management. In addition, access to the appropriate clinic and treatment facilities might be limited. All of these factors lead patients, who are in pain and out of options, to walk out of their provider's office with an opioid prescription instead. 

Inappropriate opioid prescribing can lead to nonfatal overdoses, falls and fractures, drug-drug interactions, neonatal conditions, and other medical complications. These complications result in costly, preventable healthcare expenditures, and also cause untold amounts of emotional suffering.

Several other factors have contributed to the severity of the current prescription drug abuse problem: high-dose prescriptions coupled with extended courses of treatment; increased social acceptance of the abuse of medications for non-approved purposes; and gradual but indisputable aggressive marketing by pharmaceutical companies. 

Focusing on Prevention, Intervention, and Education

To combat this epidemic, focus needs to be turned to understanding the root cause of the pain, rather than trying to mask it and manage the symptoms. Engaging and educating providers about appropriate alternative options is essential in an attempt to limit opioid prescriptions, and therefore the abuse that could result from them. 

The practice of "don't just mask the pain, treat it," is an approach that is supported and promoted by the CDC in cases where patients could pursue more conservative therapies such as physical therapy, chiropractic care, or blended therapeutic approaches to combat chronic pain. Acupuncture, yoga, massage, and progressive muscle relaxation have also been shown to be effective treatment options. 

For example, it has been amply demonstrated that if you begin to experience low back pain, you should get evidence-based physical therapy right away. Otherwise, you are more likely to pursue more aggressive treatment options such as the potential use of opioid medications, spinal injections, surgery, and other treatments.

EviCore's expertise is in applying consumer engagement, evidence-based criteria across a broad range of modalities, and a strong and diverse non-opioid tool suite. The latter includes interventional pain management as well as physical therapy, occupational therapy, chiropractic services, acupuncture, and massage therapy management. At EviCore, we believe that we have a strong arsenal to combat the growing opioid epidemic.