Since the interdiction efforts that shut down the “pill mills” and legislation to monitor scheduled medications, prescriptions for opioid medications have decreased substantially, yet mortality from opioids continues at an alarming rate. DEA enforcement and interdiction of opioids at the borders, education and prevention are sorely needed.
Certainly interdiction of the supply side of the opioid epidemic is necessary, but insufficient without targeting the “demand” side of opioid use. Specifically, the implementation of novel preventive measures, educating the public, requiring physician continuing medical education (CME) for opioid prescribing licensure, and addressing why patients use opioids in the first place.
Prevention or delaying the initiation of drug and alcohol use is the best safeguard against the horrors of addiction. This delicate balancing act requires equal parts prevention and effective treatment for the millions of addicted persons whom require comprehensive, rather than perfunctory treatment.
Rummans and colleagues, “Are Chronic Pain and the Opioid Epidemic Related”, are dead-on in their assessment of the consequences of making pain a focus of every physician visit, e.g. the 5th vital sign, which resulted in the erroneous perceived that “under-treatment” of pain was the impetus for the opioid epidemic.
Why Does This Matter?
With the recent revelation that one-third of the U.S. population suffers with chronic pain, this clearly demands better and more effective pain evaluation and treatment modalities, and should be taught alongside of continuing education for physicians on the use of opioids. The fear is that individuals whose self-efficacy and quality of life are enhanced by expert pain management, including the use of opioids, will be left wanting and suffering if we over reach in regulating the use of opioids for legitimate pain.
This excellent commentary by Srivastava and Gold, accurately describes the current dilemma between pain management and addicting unsuspecting patients via a lack of empirically derived evidence. Not only about pain and opioids, but also about alternative treatment strategies to manage patients with both chronic pain syndromes and addiction. We can, and must tackle both epidemics.
Benjamin Gold, MS. Beyond Supply: How We Must Tackle the Opioid Epidemic. Mayo Clinic Proceedings , Volume 93 , Issue 3 , 269 – 272