The Opioid Epidemic

By Mary O’KEEFE

A study released last week found that emergency room patients treated by physicians who prescribe opioids are at a greater risk for long-term opioid use “even after a single prescription than those who see less-frequent prescribers,” according to a Harvard T.H. Chan, School of Public Health release.

These findings may seem self-explanatory; however, the bigger picture may give a hint as to at least one aspect of why an opioid epidemic has gripped the nation.

According to the U.S. Dept. of Health and Human Services (HHS), more people died from drug overdose than any year on record and about six out of those 10 deaths involved opioids. From 1999 to 2014 the rate of overdose deaths involving opioids, including those prescribed as pain relievers, nearly quadrupled.

Two years ago the HHS centered on areas that they hoped would help curb the opioid epidemic that included improving prescribing practices, expanding access to and the use of medication-assisted treatment.

According to the New England Journal of Medicine in an article written by Nora D. Volkow, Thomas R. Frieden, Pamela S. Hyde and Stephen S. Cha, the rates of emergency room visits and substance-abuse treatment admissions related to prescription opioids have increased.

The Harvard study found there were inconsistencies between doctors and how they prescribed opioids. It really does matter who a patient sees when they get to the ER. One-quarter of the doctors in the study prescribed opioids to just 7% of the patients whereas at the other end of the spectrum the top quarter of the doctors prescribed opioids to 24% of their patients.

USC Verdugo Hills Hospital Dr. Michael Levine said that doctors at his hospital follow the CDC (Center for Disease Control) guidelines when it comes to prescribing opioids. ER doctors at USC-VHH, Levine said, will prescribe opioids for no more than about two days, in general, with the advice to see the patient’s general doctor for follow up treatment.

“We do not prescribe for long term,” he added.

He did say that he has found on occasion that some patients do come into the ER to obtain prescriptions for opioids, stating they need it for pain, but it is more than likely for “secondary gain” (addiction).

The CDC guidelines are set for patients who are 18 years and older, but there are doctors, and dentists, that prescribe opioids for a variety of issues including after oral surgery on younger patients. This is a concern for State Senator Anthony Portantino, who this month introduced SB419, which will, if passed, prohibit individuals under the age of 21 from being prescribed oxycodone.

“I don’t want to see another child and family go from the soccer field to drug addition counseling to tragedy,” he stated.

Oxycodone, or OxyContin, is known as an opioid analgesic and is a considered a high-risk drug for dependency, according to Portantino.

“I think the Harvard study points out that there needs to be proper regulation of opioids [like] OxyContin in the relationship to prescriptions and patients. And many states are trying to figure out what the right regulations is, whether it is dosage, whether it is [limiting the number of days or number of pills],” Portantino said in an interview with CVW. “My bill was intended to say that while everyone wrestles with the big picture of how best regulate OxyContin, we should certainly stop giving it to the most vulnerable population – our kids – and by saying no prescriptions to anyone under 21 I am hoping that a time-out will allow the pharmaceutical industry and the physicians and the regulators to appropriately address the national opioid epidemic.”

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