The Opioid Crisis is well documented, but the numbers are still staggering each time they are seen. In fact, more people are dying from opioid overdoses than from gun homicides or car crashes combined! From 1999-2015, according to the Presidential Commission on Combating Drug Addiction and the Opioid Crisis, more than 560, 000 people died of drug overdoses.
As the letter continues, since 1999, the number of opioid overdoses in America has quadrupled. In the same period, the amount of prescription opioid given has quadrupled as well. This massive increase has occurred despite the fact that there has been no increase in the amount of pain patients have reported! The dramatic escalation in the problem started, not on street corners but in doctor’s offices and hospitals.
How did this happen? In the early ’90s, there was general under-treatment of pain. “Opiate phobia” — or fear of addiction — kept pain untreated. There was a perception that people who needed opioids were “weak.” Crippling pain from trauma to cancer went either untreated or poorly treated. Then we over-corrected.
By the mid ’90s, the push was on to treat pain. It became the “fifth” vital sign and a marker for quality and patient satisfaction. Pharmaceutical companies created newer versions of short and
long term opiates, and stoked public demand for pain relief and physician guilt for inadequate treatment. The recent push for better “report cards” from patients, as well as fears of liability for inadequate pain relief, led to greater writing of opioid prescriptions. For some bad actors, all out greed led to the creation of “pill mills” which marketed themselves as pain clinics.
A federal Health and Human Services Department report found that in an effort to improve pain management, the increase in prescription opioids led to a significant rise in adverse health consequences, including addiction, abuse and overdose.
Why does this happen? Simply put, the evidence shows that the nature of the initial opioid prescription can have a marked impact on long term opiate use and the potential for abuse. According to the CDC, after an initial prescription , the likelihood of chronic opioid abuse increases fro every day after the third. The greatest increased risk is after days 5 and 31st day, a second prescription/refill, over 700 Morphine Milligram equivalents cumulative dose (a higher total dose), or a longer initial supply (10 or 30 days). The highest rates of continued use at 1 and 3 years are for those who started on a long acting opioid followed by those started on tramadol.
The New York Times reported a year ago that a stunning 75 percent of heroin addicts used prescription opioids before turning to heroin, a lower cost alternative. As the prescription of opiates decreases, addicts are turning to the street. The recent declines in prescription opiate overdoses are matched by the huge spike in deaths due to fentanyl and heroin off the street!
The dilemma for providers is simple, but hard to solve. How do they reset an expectation that pain can be managed but not eliminated? We believe its through education and monitoring. Pain Scored was developed to use validated pain Diary questions to monitor the daily benefit and harm of opiate and pain therapy. Powerful reports can help clinicians answer these critical questions:
- Is my patient taking the medicine as prescribed?
- Is my patient having a benefit with therapy on their pain?
- Is my patient having a functional improvement?
- Is my patient having a better quality of life?
- Is my patient being harmed by their opiate medication?
- Is there evidence of a dosage ceiling or opioid induced hyperalgesia?
These are questions all physicians have but cannot easily answer in one office visit or with traditionally pain diaries. Pain scored gives you simple reports that can help you answer these questions!