Read the original here at investors.com by DR. AMAR SETTY
America’s worst drug epidemic shifted into high gear ten years ago when the Centers for Disease Control and Prevention warned fatal drug overdoses in 2008 were poised to overtake the numbers of deaths caused by motor vehicle crashes.
Today, the most recent data show over 42,000 annual deaths caused by opioid abuse, which surpasses the mortality rate of car accidents by several thousand.
How is it that car crash fatalities peaked at over 51,000 in 1979 and in recent years are less than 40,000 despite more drivers? Innovations such as airbags and three-point seat belts among other technologies engineered into modern vehicles account for life-saving improvements in automotive safety.
Yet we have relatively few visible signs of similar advances in treating pain, which is what caused this drug epidemic.
The CDC states the opioid crisis began in the 1990’s with increasing prescriptions. The health care system mistakenly accepted that powerful opioids could safely treat virtually anything that hurt in the human body. Making matters worse, a wildly successful marketing campaign, later proven to be fraudulent, promoted an opioid prescription “pain-killer” drug as non-addictive.
Around the same time stakeholder interests aligned to promote pain as a vital sign equating its importance with pulse, breathing and blood pressure. The question now becomes what we learned from the 1990’s and how to successfully manage our way out of this crisis.
What might seem like an easy solution — suddenly yanking someone off opioids and cutting off supply will not work. Untreated, severe chronic pain decimates quality of life so policymakers and insurers must understand that imposing dosage amounts, limiting prescriptions and refusing reimbursement has unintended consequences, most notably inducing some to turn to illegal heroin and fentanyl.
Addiction must be addressed with a specific, long-term plan. Although there is widespread consensus on reducing opioid prescriptions overall, the challenge is doing so in a manner that respects individuals. A physician-led, patient empowered experience is essential to properly managing pain and the opioid crisis itself. This is easier said than done.
America’s health care system mostly clings to a tactical ‘fix-it’ approach, addressing short-term needs with a particular medical intervention. Physicians aggravate this situation by not spending enough time with patients, an unfortunate result of a complex health care system that imposes onerous administrative burdens on medical providers.
Nevertheless, we should view the patient should as a customer who in charge of deciding the services they consider most appropriate. While we have the technology and tools to link patients with their doctors, we’re simply not using them enough.
For example, it is standard practice for patients to keep a written diary of chronic pain to review with their doctors. Intended to pinpoint where it hurts and analyze the effectiveness of pain medications including widely-prescribed opioids such as Oxycontin, Percocet and Vicodin, these journals are merely hand-written paper notes. Analog notes can’t be readily shared or analyzed and are prone to error.
The technology exists for patients to record and share data real-time on smart phones. By analyzing data over time, physicians and patients may conclude that opioid drugs are not always as effective as alternatives to alleviating pain, as numerous clinical trials have shown.
Three out of four Americans fail to take medication as directed. Mobile applications enable patients to enter their prescriptions, set up reminders, track quantities and log dosage amounts. “Smart” pill bottles prevent diversion and monitor use. Syncing patients and their doctors with these tools makes it easier to use pain medications as directed.
Moreover, physicians can get real-time visibility into patient behavior.
A natural outcome of physician-led, patient empowerment will lead to greater understanding of multiple ways to treat pain. Interventional pain management techniques are usually out-patient procedures focusing on internal parts of the body generating pain.
Information and access to non-opioid medical therapies including acetaminophen, the key ingredient in Tylenol, local anesthetics, and other classes of drugs should be available to consumers on their own, personalized applications.
Proven, viable options to treat pain include non-drug treatments like exercise, physical therapy, yoga, acupuncture and cognitive behavioral therapy. And supervised opioid therapy, managed closely by providers aided by mobile health technology, will limit dependence and addiction for those patients where these drugs are most effective.
“Check with your doctor,” a familiar legal disclaimer which applies in medical decisions, will take on added significance when we embrace the latest technologies to facilitate better communications between physicians and patients. It is time to “buckle up.”
- Amar Setty, an MD, is a practicing anesthesiologist who is working to change the way Americans think about pain management and reduce opioid abuse.