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Prescription opiate abuse and misuse has grown tenfold during the past 20 years, creating an epidemic that seems to be propagating with no end in sight. In an October ABC poll, New Hampshire residents named drug abuse as the top issue in the state, surpassing both the economy and jobs, prompting presidential candidates to address the epidemic in campaign stops and debates. Last month, the Centers for Disease Control and Prevention estimated that almost 19,000 Americans overdosed on prescription opioids in 2014. The latest response to the growing epidemic came last week, when leaders from the U.S. Food and Drug Administration called for a plan to reassess the agency’s approach to opioid medications and develop policies to reverse the epidemic.
In 2012, one-third of opioid prescriptions were written by family practitioners or internists compared to 5 percent by pain specialists. Increasingly, primary care physicians are under fire for contributing to the problem, which can be traced back to the 1990s, when opioids were prescribed for chronic nonmalignant conditions. During this time, drug companies aggressively marketed new powerful opioids to relieve pain.
“What is really needed is a sea change within the medical profession itself,” said Richard A. Friedman, MD, Professor of Clinical Psychiatry and Doctor of the Psychopharmacology Clinic at Weill Cornell Medical College in The New York Times. “We should be educating and training our medical students and residents about the risks and limited benefits of opioids in treating pain.… It is physicians who, in large part, unleashed the current opioid epidemic with their promiscuous use of these drugs; we have a large responsibility to end it.”
In the March issue of Primary Care Reports, Charles Opperman, MD, provides an in-depth review of strategies to prescribe opioids appropriately.
“Primary care physicians may in some instances only be adding fuel to the proverbial fire,” writes Opperman. “By their very nature, physicians tend to be empathetic, caring, and have an overwhelming desire to help alleviate suffering. But when coupled with the malicious behaviors of a drug-seeking patient who is able to tug on those very heartstrings – the inappropriately equipped, well-meaning physician my find himself inadvertently contradicting one of the basic principles of the Hippocratic Oath: first, do no harm.”
Want to learn more on this subject? [On-Demand Webinar] Safe Opioid Use: Meeting the CMS CoP Hospital Requirements discusses standards on safe opioid use, IV medication and blood transfusions, as well as the ISMP IV Push guidelines for adults.
— Leslie Coplin, Executive Editor, AHC Media