Special Note: Dr David Samadi is one of the worlds most respected urologists having pioneered many of the robotic surgical procedures now used throughout the world. He is a regular contributor seen on Fox News and an esteemed colleague and friend. - Mike Huckabee
No matter what corner of the United States you may reside in, the opioid epidemic also resides. This epidemic’s vise-like grip shows few signs of letting go as it casts its shadow across communities, large and small. Just recently, a report from the National Vital Statistics System, Mortality in the United States, 2016, sobered us into the reality of what opioids have done to our nation - lowering the life expectancy rate of U.S. citizens for the second year in a row. Every day there are 100 opioid-related deaths in the U.S. – another disturbing statistic from the report.
How do we begin to solve this?
As a nation, how do we break this epidemic? What can be done to help those who are in pain but without leading them down a path of addiction?
Whenever there is a problem to be solved, you must first understand the underlying causes. From there can come forth strategic, well-thought out sustainable solutions. Fixing the opioid crisis won’t be easy but we have to start somewhere. If we don’t, our nation will continue on its current trajectory with the epidemic becoming much worse.
The history of the opioid epidemic is multifaceted. From years of illegal drug trafficking of heroin across the borders, to the 1992 Patient Bill of Rights demanding that no patient should ever experience pain. This led to doctors overprescribing for any pain at any cost. In the 1990’s came the hard push by pharmaceutical companies encouraging the expanded use of opioids such as OxyContin, claiming it was non-addictive. Even the nations’ families and communities have played a role in isolating ourselves to the point of having few meaningful connections amongst our fellow citizens. Each one of these situations has contributed to this mess of opioid addictive use.
We now know that a lot of the information in the past on the safety of opioids was wrong. They can be highly addictive and when taken in sufficient doses, can depress the respiratory center of the brain. If opioids are used for more than 90 days, they are difficult to stop. Taken at high enough doses, a person can stop breathing. If a person addicted to opioids tries to quit taking them after prolonged use, they will experience intense cravings and withdrawal symptoms.
As bad as it is, we as a nation have always managed to find a way out of tough situations in the past, making us stronger and more resilient than ever. The good news is each one of us can make a difference in our own small ways to help untangle the web opioids have built within our communities, our families, and our lives.
What must be done
A step in the right direction has begun with President Trump officially declaring the opioid addiction as a national crisis. By making this declaration, many more resources will be available to help those suffering from this tragic disease of addiction.
10-15% of the U.S. population is afflicted with the disease of addiction, but only 10% of those are able to receive help. This means for every 100 people who need help, only 10 actually get the treatment they need. By calling the opioid epidemic what it is, a national crisis, this will increase treatment availability as well as provide necessary funding for those most in need.
The White House Opioid Commission is another avenue for effectively addressing this epidemic. In a report released in November, 2017, the commission is advocating important steps which include the following:
- Expanding access and administration of Nalaxone, a drug overdose reversal medication
- Enhancing federal sentencing for fentanyl traffickers
- Eliminating the social stigma that creates a barrier for those seeking treatment
- Establishing drug courts in 93 federal judicial districts, believed to be more effective than prison sentences for treating substance abuse
- Establishing quality community addiction treatment centers that address substance abuse as a chronic health problem
A positive step taken to reduce opioid use was the recent announcement by the Food and Drug Administration announcing efforts to promote more widespread availability and acceptance of medication-assisted treatment (MAT) for opioid addiction. MAT incorporates evidenced-based treatment using anti-craving medications such as naltrexone, buprenorphine, or methadone along with comprehensive therapy and support that addresses issues related to opioid dependence. These medications have successfully helped people overcome addiction and maintain long-term recovery.
Another important issue needing addressed is the fact many of the opioid deaths in the U.S. are not from prescription or legal opioids, but rather is driven by illicit opioids like heroin and manufactured fentanyl, a synthetic opioid. The vast majority of prescription opioid patients do not transition to the use of an illegal drug like heroin. The people most vulnerable to switching to heroin are those who are also abusers of other drugs including alcohol. Not only are serious drug education policies needed, but also a law enforcement effort to prevent the flow of illegal drugs across the border.
Our healthcare system itself plays a significant role in easing the opioid epidemic. Physicians, nurses, and even patients must be willing to understand and be educated on the potential for addiction when prescribing, administering, and taking medications.
In the years leading up to our current crisis with opioids, doctor’s offices and hospitals interpreted the Patient Bill of Rights in 1992 to mean no patient should ever have any pain. Granted, opioids have changed the manner in which we treat pain, significantly helping patients’ pain experienced post-surgically or those with terminal cancer not having to suffer indefinitely.
The problem has been patients with chronic pain. The pain scales of happy to sad faces were posted in our health facilities to assist a patient in assessing their level of discomfort. Soon, Medicare, Medicaid, and other entities began to rate health systems by how well they managed pain rewarding them with reimbursements and tying their reputation on those ratings. This led to over prescribing pain medications, with people either getting hooked or giving away or selling to family or friends any unused pain meds.
The ethical dilemma for physicians is that there is no current non-addictive treatment for long-term pain. Finding more interventional strategies to treat chronic pain which reduces the amount of opioids being prescribed realizing they are not to be used as a long-term solution.
Physicians need to review a patient’s history of substance abuse and make sure no other doctor is prescribing opioids for them. Any opioid prescribed should only be written for the lowest effective dose and only for the quantity likely to be required. When a physician comes across a patient struggling with substance abuse, they should be referred to an effective substance-abuse treatment center.
By putting these steps, it puts the accountability on physicians and less opioid medicines out in the general public. It would also prevent patients from “doctor shopping” to where they go from one doctor to another asking for prescriptions for an opioid that often leads to the patient accumulating an excessive supply of these addictive drugs.
Lastly and probably the one most effective long-term solution begins in each and every home in the U.S. The family has always been the answer to dealing with the problem of any type of addiction and drug abuse. The key is prevention. Families need to be empowered and supported in their efforts to keep their loved ones drug-free. As a nation we have become more disconnected than what we were in the past. Sure, there is social media but that is not the same as being truly connected with one another. The antidote to the opioid crisis is community. If we want to keep our citizens off these drugs, make sure people in your neighborhoods actually do things together, in public. Fight off isolation. Get kids outdoors to play. Adults should be role models of compassion towards and allowing their children more human experiences instead of material things.
Strength is in numbers. If we all come together as a nation to give our very best fight in defeating the opioid epidemic, we will be stronger than ever. Our children, our lives, our health, and our future depend on it.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical contributor for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com, davidsamadiwiki, DrSamaditv.com davidsamadibio and Facebook