Author: Nikki Seay

The opioid crisis is a complex issue in the United States. Opioids kill 50,000 Americans every year, yet they’re still considered to be an effective pain reliever for chronic pain. That’s something lawmakers hope to change by implementing more training programs for doctors and providers prescribing opioids.

The Scope of Opioid Prescribing in the US

The CDC indicates that opioid prescribing has decreased in the last few years — from 259 million prescriptions in 2012 to 153 million prescriptions in 2019. However, 153 million prescriptions still amounts to nearly two thirds of all adults in the United States getting a bottle of prescription opioids. That’s pretty staggering when you think about it.

Fueled by concern in his community in West Virginia, Senator Joe Manchin is pushing the Food and Drug Administration to provide additional safeguarding training for healthcare providers prescribing opioids — something that is long overdue according to treatment providers and recovery advocates. 

Karren Simonsen, a practice nurse from the Mid-Atlantic Recovery Center, told reporters that providers need to be held accountable, and that doesn’t just include doctors. “It’s important that not only are primary care providers educated and held accountable for the prescriptions that they’re writing, but also dental providers because that’s something that we see often,” she said. 

Other treatment providers at MARC said it is critical to know about people’s backgrounds and any co-occurring disorders before treating those at risk of misusing opioids.

The Risks of Opioid Use

There are multiple factors at play with the use and prescribing of opioids: patients are struggling with chronic pain and, in an attempt to  alleviate that pain, doctors rely on information they’ve been provided about opioids as an effective painkiller. 

Chronic pain is defined as pain that lasts more than three months and can be the result of an underlying medical condition or injury. It is estimated that over 100 million Americans live with chronic pain, which can be really challenging to manage.

While doctors did not know this initially, it has come to light that there is a significant risk associated with opioid use in the development of opioid dependence and even addiction (opioid use disorder). The true risks were withheld by opioid manufacturers, when they lied and misled doctors, telling them that opioids were safe and effective for the treatment of pain. The New York Times reported that Purdue Pharma knew there was significant abuse of their drug “OxyContin” years after its introduction, and they concealed that information. 

By that time, however, America was already dealing with an opioid crisis. According to the National Institute on Drug Abuse, opioid use disorder affects three million  Americans each year. 

In 2020, 93,000 Americans died of a drug overdose which is a 30 percent rise since 2019. Dr Nora Volkow, the director of the National Institute on Drug Abuse told NPR, “This is the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999.” Volkow described this rise as “chilling” and another sign that the opioid crisis and COVID-19 pandemic are having a deadly effect on the US. 

“This has been an incredibly uncertain and stressful time for many people, and we are seeing an increase in drug consumption, difficulty in accessing lifesaving treatments for substance use disorders and a tragic rise in overdose deaths,” she said.

Prescribing Opioids for Pain Relief

Opioids are still the most commonly prescribed medication for pain symptoms or a pain-related diagnosis, and prescriptions are most frequently written in general and family practices. A staggering 20 percent of patients reporting symptoms of pain will be given an opioid. 

In writing the facts about opioids, it’s also important to put this information into context. There are thousands of stories online about how individuals live every day with chronic pain, and, worse, those who can’t get adequate pain relief. 

For example, Beth has lived with chronic pain for over 18 years, beginning from sciatica. The pain now extends to her lower back, arms and various parts of her body. Medication, among other lifestyle factors she says, “is a necessary and core tool for me in the management of chronic pain.”

Conversely, there are thousands of stories about people who have struggled with pain medication, such as Britton, a veteran who struggled with prescription opioids following an injury, Stevi Rae who struggled with addiction after a car crash and the use of prescription opioid medication, and Ann Marie who tragically lost her son to a prescription opioid overdose. 

The CDC states that prevention, assessment, and treatment of chronic pain are challenges for healthcare providers and systems, with a lot of pain going unrecognized, particularly among racial minority groups, women, the elderly, those with cognitive impairment, and those at the end of life. 

Is training the answer, or should there be more restrictions on opioid prescribing? The Centers for Disease Control and Prevention (CDC) seem to think it’s a combination of both.

CDC Opioid Prescribing Guidelines

CDC data shows that since 1999 deaths from prescription opioids have increased more than five times — a loss of over 200,000 Americans have died from prescription opioids.

The CDC states that they are committed to combating the opioid overdose epidemic by improving the way opioids are prescribed. They provide clinical practice guidelines that can ensure patients have access to effective pain management but they also reduce the risk of opioid use disorder and death. 

The CDC Guideline for Prescribing Opioids for Chronic Pain provides clear recommendations to the prescribing of opioid pain medication.

The CDC also collects data to monitor trends and advances research, about opioid use; builds state, local, and tribal capacity to increase prevention activities and use data to inform a public health response to opioid use; supports providers, healthcare systems and payers with the ability to make evidence-based decisions that promote patient safety and improve opioid prescribing; partnering with public safety officials and community organizations; and increasing public awareness about opioid misuse and overdose.

While the FDA is being challenged by lawmakers to provide training to opioid prescribers, there is little information about such a training program. However, the FDA clearly states on their website that their highest priority is to advance efforts to address the crisis of misuse of opioid drugs harming families. Their approach seeks to decrease exposure and prevent addiction, support addiction treatment for those with opioid use disorder, foster the development of new novel pain therapies, and improve enforcement and assess the risk/benefit of opioids. 

If you or someone you love is struggling with a substance use disorder, help is available. Call 800-934-1582(Who Answers?) today.