December 27, 2017

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 TwitterInstagramPintrestSamadiMD.comdavidsamadiwiki, davidsamadibio  and Facebook

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Comments 1-13 of 13

  • Audrey Skarness

    01/02/2018 12:54 PM

    As long as there are drug dealers on the streets, it will never end.

  • Michael Kamrath

    01/02/2018 12:48 AM

    Black kids dying from crack overdoses? Ah, those were just thugs. Now our poor white kids are dying? Poor kids, we must help them.

    But go ahead, boycott the NFL. Those dummies are just making up a problem. Why are they gasping for air? MY breathing is just fine.

  • Lori Croci

    12/29/2017 12:11 AM

    I enjoy reading your commentaries and your perspectives on these varying issues. Recently I have become more aware of human lives in their addictions. Very sadly, I have found out that our government claims victory in helping people addicted to heroin by giving them methadone to "wean" them off. However, no one ever points out the fact that they give daily doses of the methadone out for long periods of time which gets them addicted to this drug, freely given to them by our government, paid for by our taxes. They do NOT reduce the doses of methadone to get them off of that addiction, however. Back to the Pharm companies ruling our government... My husband and I have decided to do something about it, one step at a time. We have opened a transitional living home, and in the process of opening 2 more. Those who truly want to get clean and stay clean are able to come into our program. They have strict rules to follow, have to attend 2 meetings a week, have to work at least 20 hours a week to pay their own way, are drug tested randomly and are held accountable. We are already having success in our program. We encourage the, respect them as human beings, not like dogs on a street or packing them in to get statistics of homeless to drop. We offer training for work so they can sustain a job. Most of all we show them we value each and every one of them and their situation. It can be done but we as a community need to not shut our eyes to the problem but give a little of our time to show them they are truly cared for.

  • Jean Irwin

    12/28/2017 09:36 PM

    My late husband had several back surgeries which led him to getting addicted to opioids, benzodiazipines, etc. He went through 3 chemical dependence treatment centers to no avail. He suffered from what was called "rebound" pain- pain caused from taking the drugs, mood swings and suicidal thoughts. Our experience was that doctors know how to prescribe these potent pain meds, but don't know a thing on helping a patient get off of them. This included pain management doctors. As a general dentist by profession, I could never figure out how doctors got away with supplying never ending prescriptions for these drugs over and over with no consequences. It was drilled into us as dental students not to over-prescribe, and be very conscious about possibly contributing to someone becoming addicted. I was also told by a physician with obvious irritation, that my husband wasn't addicted to percocet or valium, he had built up a tolerance to the drugs. I contend the end result is the same. I partially blame the medical profession's over-prescribing of these drugs, which eventually contributed to my husband's suicide. He often lamented that he felt like an experimental lab rat on an exercise wheel and couldn't get off. So I guess my point is: a lot of opioid, etc. addictions are "legal." As Dr.Ron Paul has stated," a lot of illegal, street drugs are easier to get off of than prescription drugs." My husband witnessed this at the treatment centers.

  • Cheryl mariner

    12/28/2017 08:11 PM

    This is a load of crap. Methadone is worse than opiates and as addictive. These actions will have no results. Why do all the other countries except the U.S. use ibogaine? Until communities have longterm treatment and funding. The same ole same ole is not goingto work.

  • Bruce Deming

    12/28/2017 06:42 PM

    This is a problem that can't be solved by arresting all the addicts. Current treatment is based on 12 step AA models and at best is 5% effective. Even AA has admitted this fact, just google the Orange Papers. The Orange Papers also find that the cure rate for those quitting themselves is 5%. Not many doctors can prescribe subutex and suboxone and the ones that due are working with drug courts in concert with pain management facilities. You will never get an addict to voluntarily attend pain management due to the invasive nature and legal jeopardy they cause. Any physician should be able to prescribe subutex or suboxone and keep the information private under doctor patient confidentiality. In New York State, if you are prescribed any opiod, the information is submitted to a data base that is made available to all physician's, pharmacies, and law enforcement agencies. This is a clear and blatant violation of federal hipaa laws. The entire treatment model must change or this crisis will only grow. Making criminals of these addicts will force them further from treatment, many of them seeing death as the only answer.

  • James Kelly

    12/28/2017 11:40 AM

    Been in pain several times, first from a near-fatal auto accident, last from pulmonary blood clots (20% chance of survival), probably one other time which forget. Very, very pleased to have been given Vicodin. Stopped pain, permitted me to sleep, with last problem Vicodin decreased just plain misery late in the day. When it was time to stop I stopped, no problem.
    Also recall that years earlier I could not get anything from my dentist but largely worthless OTC for the extreme unpleasantness of a toothache. Resorted to alcohol + an OTC, bad combination.
    Sorry for all those killing themselves with drugs, sympathy limited as I think the national response will be to make it much harder for me to get relief next time something Bad happens. Maybe they will play nice music for me. Republican or Democrat, all they can do is make things worse.
    It does seem true that those elderly I have known in Hospice or a Nursing Home seemed to get all the morphine sulfate they could swallow, to Help Them Through.
    Just my observations.

  • Karen Wheat

    12/28/2017 10:53 AM

    I have been in constant, chronic pain since 1998. I'm allergic to most of the meds my physicians have tried on me. I'm 54 years old and the four different pain syndromes that affect me have caused a great deal of disruption in my life. I take Tramadol every day, three times a day, and I use Fentanyl patches when absolutely necessary. Why am I telling you this? Because I am not a drug seeker, I use my meds properly and conscientiously without issue. My team of physicians are all "on the same page" where my many (other) health issues and medications are concerned. But, there are many like me and it is incredibly difficult to obtain the medicine that controls, to a tolerable degree, the pain that never leaves. The prevailing notion that everyone trying to get stronger prescriptions is a drug seeker, really hurts those of us who need opiates just to live day to day. So, while I agree that there's a crisis regarding overdoses and the ease of getting these drugs from almost anybody "on the street", there needs to be a caveat for folks like me. And the door to real pain relief shouldn't be slammed in our faces.

  • CDR Marcia Standifer, Ret., USPHS Commissioned Corps

    12/28/2017 10:22 AM

    Thank you, Dr. Samadi, for a well-thought out and reasoned approach to this crisis. Very good article!
    May I suggest it be submitted to some news outlets as an opinion/op-ed piece. You need to disseminate your ideas, to add to the nation's approach to this problem.

    Too many of our leaders want to eliminate the effective drugs completely and/or punish the efforts of our health care professionals in dealing with clients in chronic pain. Pain Management Contracts, properly between clients and health care professionals have always been an effective means of dispensing these meds while tightly controlling the use of these dangerous drugs.

    Many of my clients were enabled -- to live full, happy lives --- able to hold jobs and support their families while taking the minimum effective dose required for them to do so.

    God bless the efforts of Governor Mike Huckabee and you, Dr. David Samadi, for your efforts to add to the public discourse and steer these conversations to rational and effective public health solutions.

  • CDR Marcia Standifer, Ret., USPHS Commissioned Corps

    12/28/2017 10:08 AM

    "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 (emphasis mine) ...."
    -- And what did our previous administration do, but block a multi-agency, multi-country task force (Project Cassandra) effort to prevent the back and forth flow of heroin and money from the Hezbollah network to the U.S. - just because they didn't want to make Iran mad while they were working on the failed Iran Nuclear Deal.

    Shameful, yes, but also TREASONOUS! We'll never know, probably, how much that contributed to the current opioid crisis, but my thought as a career US Public Health Service officer and medical provider is: A LOT!!

  • V Fiore

    12/28/2017 10:07 AM

    Without insurance, no one is going to touch them....the problem being treating the symptoms and not the problem.

  • Fred Moore

    12/28/2017 10:03 AM

    The hoax and fraud surrounding Marijuana Cannabis may reveal itself as it becomes the medium to free thousands from their opioid addiction.

  • Jay San

    12/27/2017 03:56 PM

    And you forgot in this whole thing that medical community as a whole needs to start developing CURES for aliments. Not symptomatic medicine that just treats a condition. If they actually cured people (yeah hard concept to understand I guess) you would have a lot less people in pain, thus less people seeking a medication to take the pain away. That's the root problem!!!!