It is hard to imagine that Opioid use has quadrupled in the past 15 years, claiming 183,000 lives, according to the Center for Disease Control. Fair Health, a nonprofit organization committed to Healthcare, says claims increased 3,203% for Opioid patients diagnosed from 2007 to 2014. The common forms for Opioids are Heroin, Oxycodone and Hydrocodone, also known as Vicodin. White men represent the largest group prone for Opioid overdose.
This rapid increase in opioid use created a nationwide health emergency. The jump in prescriptions caused a ripple effect in the American Healthcare system that had already experienced a wave of change with the Affordable Care Act. Fair Health reports, “non-medical use of prescription Opioids alone was estimated to have cost the U.S. economy $53.4 billion in 2006.”
So what does the Healthcare opioid crisis look like? Everyone wants this addictive pain killer. One of the problems is a single patient can refill one prescription with multiple doctors who financially benefit for promoting the drugs. The number of refills increases when patients can travel over state lines. This phenomenon of patients selling their medications to others has caused a significant amount of unintended consequences.
There have been state improvements to eliminate double dipping by patients. In Michigan, a model that streamlines the prescription system allows doctors to instantly see the history of patients on addictive drugs. A GCN special report says “the state will begin using Apprises’ next generation substance abuse tracking platform: NarxCare. Part analytic tool, the new system automatically analyzes MAPS data and a patient’s health history to provide a patient risk score, or NarxScore.”
The most recent data demonstrates that half of the overdosed patients require medical admissions. The nature of overdoses surged the number of emergency department (ER) admissions that are often not fully covered by insurance. The length of stay is approximate four days costing an average of $30,000 in care. Also, 22% of these patients required nursing facilities because Opioid overdosing can causes brain damage. The current numbers are 100 patients per day die from opioid overdose. This is fast overcoming the number one killer in the United States.
As an anesthesiologist and pain physician, I specialize in treating the whole patient. I listen to my patients describe their pain. My medical decisions are based on more than a number on a scale of 1 to 10. This total care approach is more comprehensive which creates a greater chance that the patient will experience relief from their pain symptoms.
Opioids and Corporate Greed
Some think the American way of making a buck is at someone else’s loss. This philosophy seems apparent in the Pharmaceutical industry, and its relationship with Opioids. “80 percent of people with substance abuse problems start their downward spiral with pharmaceutical pain relievers,” the Sun Miami Sentinel reported.
Then, there’s the disturbing legal developments. One case in Virginia handed down a conviction to pharmaceutical executives, but did not give them jail time. The New York Times reported that three executives were given probation and fines for misleading their brand, but no hard time. This sends a signal to other high paid industry experts, that despite clear evidence that their drugs are causing deaths, they could essentially get away with murder. “Purdue Frederick, the holding company, agreed to pay $600 million in fines and other payments and the executives agreed to pay $34.5 million.” Unfortunately, that is just a drop in the bucket and does not bring back the lives of those who died of opioid overdoses.
In the healthcare system, getting paid is also a major incentive driving opioid abuse. Patients can be held hostage in a system where they never are completely healed, but instead medicated. Patients reporting that they were not treated adequately can affect, Medicare reimbursement and physicians’ pay. We see the exact same problem at hospitals. Hospitals are encouraged to make sure patients have enough medications so the hospital can receive a favorable rating. Yet these tactics don’t solve the pain issue and often take additional money from the patients in co-payments or drug store refills.
The best way to solve this cycle is holistic treatment that utilizes specialists. First, we need to stop the number of oral pain medications that a patient gets monthly. Recent studies demonstrate that postoperative pain requires 12 pills versus the 30 physicians typically prescribe for a month. This opens the door for drug abuse or patients selling their extra pills or having someone they know steal the extra supply.
Second, patients with chronic pain should think holistically in terms of healing vs. just taking pills. Creating management techniques outside of medications could help break the cycle of Opioid abuse. Hopefully, this will reduce the need of opiate-based therapy or decrease the amount of pill therapy.
Third and perhaps most importantly, is treating addiction. A chronic medical illness cannot simply be solved with more medication. Treatment for addicted patients must be a high priority in their overall care. Successfully treating addiction will help the patient from feeling shame, hopelessness or depression. So addiction must be treated like other medical conditions and not simply ignored. This invariably could involve medicine, but also more importantly counseling.
This broad approach will address those suffering with opioid addiction and more importantly decrease the number of new cases. The healthcare industry must also focus on patient care vs. the money oriented pharmaceutical industry which is content keeping patients stuck in a cycle of drug dependency.