Opioids & Substance Abuse

More than 80% of the world-wide prescription of opioids occurs in the United States.  Although the prescription of opioid analgesics for the treatment of acute and chronic pain appears to be humane and generally benign, even short-term use of opioids has been associated with a clinically significant rate of abuse and addiction. Addiction develops differently in each person. An individual may take one hit of cocaine or one puff of crystal meth and become hooked.  Studies have shown that some people become addicted to medicinal opioids taking it for acute pain in as little as three days.

In 2001, the Joint Commission of Hospital Accreditation (JCAH) created a Pain Management Standard that made pain a fifth vital sign. The JCAH required hospitals, surgical centers and healthcare providers to ask every patient about his/her level of pain and provide adequate treatment of that pain. Hospitals and physicians were expected to provide patients with pain medication after injuries, surgery and painful conditions. This created a major philosophic change in the use of narcotics in the United States.  At the same time, pharmaceutical manufacturers were creating new and more powerful opioids and increasing the opioid supply in accord with the increased need created by the JCAH requirements. Associated with the increase in opioid prescriptions, psychotherapeutics, tranquilizers, stimulants, and sedative requests and prescriptions also increased. The perfect storm!

A National Survey in 2006 on Drug Use and Health reported  that 7.0 million or 2.8% of all persons aged 12 or older had used prescription type psychotherapeutic drugs nonmedically in the previous month, 16.387 million, or 6.6% of the population, had used in the previous year, and 20.3%, or almost 49.8 million, had used prescription psychotherapeutic drugs nonmedically during their lifetime. 

Physicians and the medical establishment have been purported as a major cause of the medical to nonmedical increase in the availability and use of opioids. Although there are many more reasons for the increase in opioid use, the medical establishment can help to significantly reduce the use of opioids and other psychotropic medications. Alternatives to these medications should be considered first in the treatment plan. Patient and medical provider education as to alternative therapies can create a major change in the concepts and direction of care. Interventional procedures can be developed that can save money and substantially minimize pain. Some alternative treatments will require more time and work, however, the changes in outcome will have a profoundly positive effect for our patients and their families.

- By: Lawrence Gorfine, MD