President Donald Trump held a “listening session” about opioids and drug abuse at the White House recently. The gathering included former addicts, parents of children who had overdosed, top federal officials and others. Trump vowed to make drug treatment more widely available — a worthwhile goal with bipartisan appeal. He also spoke of strengthening law enforcement and dismantling drug cartels.
But there is a cheaper, low-risk tactic for curbing some opioid misuse that was neglected: changing doctors’ prescribing habits and better educating patients. A recent study found that for every 48 patients who receive an opioid prescription in the emergency room, one will likely become a long-term user. A more cautious approach to prescribing could save lives.
Across the United States, health care professionals wrote 249 million prescriptions for opioid pain medicines in 2013. In 2015, about 22,000 Americans died after overdosing on some form of opioid drug, legal or illicit, according to the Centers for Disease Control and Prevention. Of those deaths, 15,000 were attributed to prescription opioid overdoses. In fiscal 2015, Texas pharmacies dispensed almost 7 million prescriptions for the opioid painkillers hydrocodone or oxycodone alone.
There is no medical explanation for the rise in opioid use. Sales of prescription opioids nearly quadrupled from 1999 to 2014, even though Americans don’t report having more pain now. Prescribing rates vary widely among states, even though health conditions don’t. Even among doctors working in the same emergency room, some prescribe opioids much more frequently than others.
The federal government — along with some states and professional associations — has produced extensive prescribing guidelines. Opioid medications are not the preferred option for managing chronic pain; doctors and patients should try other approaches first and carefully weigh risks before starting prescription opioids. For acute pain, such as after surgery, doctors should prescribe the lowest possible dose of opioid for the shortest duration. Prescribers must be especially careful with older adults because opioid painkillers can put seniors at higher risks of falls and fractures.
Pharmacists, patients and lawmakers have an important role.
And the public can help, too. How do most people who misuse prescription pain medications get them? One large study showed that about half obtained them free from friends or relatives. So, if you have pain pills left over from surgery or dental work, drop them in the toilet. Really. These medications are so dangerous when misused that the FDA recommends flushing them down the sink or the toilet if you can’t find an official drug take-back event. That will keep everybody in your home — you and your friends, relatives, kids and pets — safe.