So it’s official. The opioid crisis is a national emergency.
The grim statistics support that conclusion. About 52,000 Americans died of a drug overdose in 2015, or a rate of 142 each day. The numbers for 2016 will almost surely be higher once the final figures are calculated.
I’m pleased that the president declared a national emergency. Although in his brief remarks yesterday he did not commit his administration to any specific policies, his declaration suggests he will support efforts to make treatment for drug addiction more widely available. This is absolutely necessary. We also need to ensure persons with mental health issues receive appropriate care. As the president’s Commission on Combatting Drug Addiction and the Opioid Crisis found, approximately 40 percent of those with a substance abuse disorder have a significant mental health problem. For these individuals, their addiction, although serious in itself, is likely a symptom of a grave underlying problem.
I’m less pleased with legislation that has now been adopted by 17 states—and may be adopted by the federal government—which places significant restrictions on a physician’s ability to prescribe opioid painkillers based on the physician’s individualized assessment of the patient’s needs. The regulations vary from state-to-state, but the trend appears to be increasingly tighter restrictions. Kentucky recently adopted a law limiting opioid prescriptions for acute pain to three days.
There’s no question that the overprescribing of opioids by ‘pill mills’—typically self-described pain clinics—was a major contributing cause of the rise in opioid addiction in the 1990s and early 2000s. How many individuals innocently became addicted because they were misinformed about the risk of addiction as opposed to those who became addicted because they consciously sought a relatively cheap high is not known and is perhaps unknowable and is, in any event immaterial, as whatever the patients’ motivation, the prescribing physicians acted unethically and, perhaps, illegally. But the fact that opioid painkillers can be, and have been, improperly prescribed should not cause us to lose sight of the fact that opioid painkillers serve a legitimate medical purpose.
Yes, many Americans have become addicted to opioids, and some of those first became addicted as a result of prescribed medication. However, many, many more Americans have used prescribed opioids responsibly. They have not become addicted. Instead, they have benefitted tremendously from the relief that opioid painkillers can provide. I know because I am one of them.
Without getting into too much personal information, I was diagnosed with psoriatic arthritis in 2010. At one point, my condition was so severe that I could hardly walk. After various therapies failed (please: I never want to hear the word “holistic” again), I was prescribed celecoxib (brand name: Celebrex). This drug was almost immediately effective. Unfortunately, over time, it began to have serious side effects. To help me deal with the pain while reducing my use of celecoxib, my physician prescribed the opioid hydrocodone. Through the judicious use of hydrocodone over the last few years—on average, about three 5 mg pills a week—I have managed to wean off celecoxib and still manage my arthritis. I have no craving to move on to stronger drugs, nor at any time have I sought to increase the number of pills prescribed.
Tens of millions of others have also managed their pain through opioids—allowing them to carry on productive lives that otherwise might not have been possible—without becoming addicts. The opioid crisis should not obscure the fact that those who become addicted as a result of using painkillers remain the exception, not the rule.
Each patient is different, of course, but that’s precisely why the recently enacted laws mandating what physicians can prescribe constitute an improper interference with the practice of medicine and the physician-patient relationship. Physicians, not politicians, should determine a patient’s treatment.
Sometimes we must sacrifice personal benefit and personal freedom for the greater good. That’s understandable. But this public policy principle does not justify imposing onerous restrictions on the use of opioids for the treatment of pain. Doing so would penalize those who use these drugs responsibly because some abuse these drugs. Such a policy has no precedent in the modern practice of medicine.