“What are the ways to solve the current opioid crisis in the US?"
Every year, tens of thousands of Americans die from opioid overdoses — in 2017, 33,000 people died, not only for illicit drugs like heroin but also for legally prescribed opioid-based anesthetics by doctors. According to AAMC: “The rate of overdose related to prescription painkillers and other opioids within the U.S. has increased. 91 Americans die each day from an opioid overdose (including prescription opioids and heroin), according to estimates from the Centers for Disease Control and Prevention. The opioid addiction epidemic began around the mid-1990s when doctors in the United States were faced with a growing number of patients complaining of chronic pain. Pharmaceutical companies almost instantly took advantage of this. They began to advertise opioid-based drugs by any means and also to convince doctors that it is safe to prescribe this type of drugs and that it is highly effective. At that time, health care workers were exhausted by a large number of patients with chronic pain of various origins, so they heeded the calls from corporations and began prescribing such drugs to patients to alleviate the suffering more quickly and easily. Thus, prescription drugs of the opioid group are widespread in the United States. To better understand what is at stake, it is necessary to say a few words about what opioids are. These are substances with structural similarity with morphine which have strong analgesic and sedative effects and are widely used in medicine as powerful painkillers. They, however, can cause a person to euphoria, and in most cases, their use causes a strong dependence. Substances produced from a certain type of poppy are called opiates, and the whole group of substances along with those that are produced synthetically are called opioids. One of the first common opioid preparations was oxycontin which appeared on the American market in the 1990s. This medicine was directed by the doctors to take twice a day to not feel pain because one tablet was able to relieve symptoms for 12 hours. Over time people came to doctors complaining that they did not have enough drug actions and doctors forbade to take the drug more often but only slightly increased the dosage. In the end, people faced the syndrome of refusal and either began to look for other ways to get more medicine or tried to find more potent substances. As an addiction specialist from Stanford University, Anna Lembke emphasizes: “on the one hand, pharmaceutical companies are to blame for this as they were trying to make as much money as possible. They presented that drugs as absolutely safe, but in fact, the risks outweighed the benefits in most cases. On the other hand, doctors who have been under pressure from state structures, medical associations, etc., have made and continue to make a huge contribution to the crisis. But they are trying to deal with suffering patients as quickly and easily as possible". Many doctors either do not know how to treat certain serious diseases that cause severe pain in people or they require too many complex procedures to diagnose.
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Another reason for the growing number of people with opioid dependence is the volume of drugs that doctors prescribed to patients. For example, as The New York Times noted, some people have prescribed a week-long course of opioid drugs after the wisdom tooth had been removed whereas it was enough to take painkillers only one day after the operation, besides, simple analgesics such as aspirin or ibuprofen were quite suitable for this. The doctors gave the patients medications "with a reserve" so that they would not register for another appointment and they would not have to prescribe another course or other procedures. In some cases, doctors, especially in disadvantaged areas, are trying to earn extra money and sell potent drugs to people for cash. However, not only pharmaceutical giants and medical institutions are guilty of the opioid epidemic - in many ways, the problem is complicated by the situation with medical insurance. According to the National Academy of Medicine:" in 2011, about 100 million American adults suffered from chronic pain". Many of them are aware of the dangers of taking opioids and therefore would prefer to resort to alternative methods of treatment: procedures, folk remedies, exercise. However, such methods are simply not affordable for a significant part of the US population because they either cannot afford health insurance or cannot receive such assistance within the framework of the existing plan. Therefore, people are forced to take inexpensive opioid medications to at least somehow relieve pain.
In the past few years, since the press and drug treatment experts have been able to draw attention to the epidemic of opiate addiction, fewer painkillers have been prescribed in the United States but the number of deaths from overdose is still increasing. Thus, there are some ways to solve the opioid crisis: stop excessive prescription of opioid painkillers and make it controlled and restricted by the government, ensure the availability of addiction treatment.
Now the prescription for opioid medicines is easily obtained from a doctor and in most cases, insurance companies cover these costs. "In 2015, nearly 250 million prescriptions for opioids were written in the United States - more per capita than in other countries."(Madras). As a result, opioids have become a powerful 10 billion industry. There are noticeable discrepancies between the amount of the prescribed drug and the actual medical need. According to the CEO of one of the pharmacy chains: "dislocation in the ankle area or a dental procedure does not require the prescription of 30 or 60 powerful painkillers." The Presidential Commission also highlights:" the problem of excessive opioid prescriptions connected to weak training of specialists in the treatment of pain and relieving pain". That leads them to turn to opioids. In this regard, the US Centers for Disease Control and Prevention have reviewed current clinical guidelines with current data to reduce the number of prescribed opioids in the treatment of chronic pain (Prescott). However, along with an excessive opioid prescription, there is another problem: alternative pain treatments may be more expensive and insurance companies may refuse to cover them. For example, a 30-day supply of opioid pills costs $ 10 while a single physiotherapy session costs $ 25. In other countries of the world, the opposite problems relate to painkillers. It is very difficult to receive and prescribe the necessary medications: the procedure requires a lot of documents and doctors usually fear criminal liability even for minor errors in the treatment of opioid analgesics - for example, for the accidental loss of a drug ampoule. Based on the Association of Professional Participants in Hospice Aid, 37.8% of the doctors surveyed fear criminal prosecution for such mistakes (Chen). In this way excess of opioid prescriptions should be regulated and tightly controlled by the government. For right now the federal authorities still do not fully understand the scale of the problem. That leads to deplorable situations and the opioid crisis in the country. Taking the first steps towards solving opioid problems - will be helped by new administrative measures including changing the rules of control.
When we talking about the opioid problem and how to solve the crisis it is important to pay attention to people who already in addiction. According to the National Drug Use and Health Survey: “treatment for opioid addiction receive only one out of four in need". At the same time, there is convincing evidence that the use of drugs in combination with psychotherapy can reduce opioid addiction. Drugs like methadone, buprenorphine, and naltrexone can also be used to treat people with addiction. But their combination with behavioral therapy, which teaches people how to cope with their problems and motivates them to change, is optimal”. The main problem is that, in contrast to readily available opioid therapy, treatment for opioid dependence is often unavailable. The main problem is limited medical treatment insurance: insurers pay only about 60% of the cost of treatment and the rest is paid by the state or local funds or the patient. Among other obstacles: inattention of general practitioners to the possible problem of dependence and the lack of high-quality drug treatment. Therefore, for a successful solution to this problem access to medical treatment must be ensured. Moreover, according to experts, to help people who already suffer from opioid addiction it should be allowed to treat drug addicts at the expense of the federal budget. This will reduce the burden on regional funds and develop uniform standards for assisting the country. It is very important to mention that successful overcoming the opioid crisis means focusing not only on future patents but also on already addicted people.
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Another approach, through which can to combat the opioid crisis is in some cases to refuse drugs altogether. Patients do not have to endure unpleasant feelings: some of the methods focus to ease the subjective sensation of pain, forcing a person to distract from it. Oddly enough, these methods work. They are not able to remove the intolerable "oncological" pain, but they are quite capable of making life easier, for example, to patients of surgeons. For example, one of the “entertainment” method of analgesia without drugs is the use of virtual reality. Studies show that immersion in the world of VR works just as well as traditional medicines even with acute pain. "Back in the late 1990s, virtual reality began to be used in the treatment of burns. Specially designed games and VR tours help patients withstand the strongest discomfort while a specialist treats awound or performs physiotherapy”(Blackwell). One of the most famous VR games created for patients of burn wards fully justifies its name - Snow World. The player travels through the snow-covered landscapes and with the help of light movements of the head throws virtual snowballs at penguins, snowmen, and mammoths. The technique has been used for more than 20 years and patients note that during the procedure combined with the game the pain does not seem so strong. Another VR game helps people with chronic pain. The plot of the application Cool! in many ways similar to Snow World: while walking through a virtual park with a lot of distracting details, a patient needs to throw iridescent soap bubbles at a target. "A study in 2016 showed that the game was able to alleviate the symptoms of chronic pain in all thirty participants in the experiment". Of course, none of the new methods of anesthesia will become a panacea: the drug may not undergo clinical studies, and the non-drug method will be completely useless for some patients. Sounds hopeless? Not at all. It is this unpredictability of experimental analgesics that makes scientists look for more and more new means - and this means that more and more people suffering from pain will get the hope of finding the right medicine.
In conclusion, important to say that today scientists are working on new drugs that can relieve pain as effectively as today's prescription opioids or even better and at the same time will not cause dependence.“The US National Institutes of Health (NIH) has awarded more than US$350 million to four research teams that will test ways of reducing accidental deaths from opioid use. The scientists will conduct their work in four states: Kentucky, Massachusetts, New York and Ohio. A fifth group, at RTI International in Research Triangle Park, North Carolina, will coordinate the overall effort”( Reardon).Maybe someday the tools will make a significant contribution to solving the problems of pain relief. But for right now to combat opioid crisis we should pay attention to reducing the impact of opioids and preventing the development of a new addiction. Moreover, the approach to the problem should be comprehensive. First of all, the opioid prescription should be prescribed by a doctor in severe cases of illness only, for example, cancer, secondly, should be provided free or low-cost medical treatment for those who have already become addicted and the government should pay more attention to this problem and take measures at the state level. The totality of all these actions may lead to a decreasing number of people who can be addicted. The first step towards this should starts from elimination the ease of accessibility of opioid drugs by creating a tight settlement of law.
- Reardon, Sara.“US health agency pours $350 million into faight against opioid crisis”. Nature journal of science,18 Apr. 2019 https://www.nature.com/articles/d41586-019-01288-2
- Tannaz, Rasoul.“Responding to the Opioid Epidemic Through Education, Patient Care, and Research”.AAMC news,20 Jun. 2019, https://news.aamc.org/for-the-media/article/medical-schools-address-opioid-epidemic/
- Darrell, Kirch." Them Doctor’s Dilemna" Huffpost16.Aprl.2016.https://www.huffpost.com/entry/the-doctors-dilemma_b_9685832?guccounter=1
- Prescott, John. "Academic Medicine Responds to the Opioid Crisis," Marshall Journal of Medicine: Vol. 2: Iss. 4, Article 3.20 Oct.2016.DOI: http://dx.doi.org/10.18590/mjm.2016.vol2.iss4.3 https://mds.marshall.edu/mjm/vol2/iss4/3
- Meldrum, ML. “The ongoing opioid prescription epidemic: historical context” Am J Public Health. 2016;106(8):1365–1366
- Madras,BK. “The surge of opioid use, addiction, and overdoses: responsibility and response of the US health care system”JAMA Psychiatry. 2017;74(5):441–442
- “National Academies of Sciences, Engineering, and Medicine. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use”. Washington, DC: National Academies Press; 2017.
- Kneebone E,Allard SW. “A nation in overdose peril: pinpoiting the most impacted communities and the local gaps in care”.28 Sept, 2017. https://www.brookings.edu/research/pinpointing-opioid-in-most-impacted-communities.
- National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 6 Mar. 2018, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.
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