Like many, the Opioid crisis has struck so close to home for me and left me feeling confused and helpless. I have been touched by others who have lost a relative or friend, or who have died in conjunction with their own personal use of the drugs. I see the individual prescribed these drugs for an indeterminable amount of time being dropped from medical practices that no longer exist or which have demonstrated a “knee-jerk” response to the crisis.
In my attempts to respond, I have launched my own investigation into the crisis and what I learned and understand I am now sharing with you. In this post, I’ve provided a grid with pain management solutions. Some of these may be familiar to you and some may give you new options to share with those in need.
My hope is this will enlighten and provide some benefits to you, your loved ones or friends. I encourage you to consult me or your Primary Care Physician on any of the content I’ve shared.
— Dr. Andrews
Drug Overdose Deaths In The United States Continue To Increase In 2017
Drug overdose deaths and opioid-involved deaths continue to increase in the United States. According to the Center for disease Control (CDC), the majority of drug overdose deaths (more than seven out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses.
91 Americans die every day from an opioid overdose.
The most common drugs involved in prescription opioid overdose deaths include:
- Oxycodone (such as OxyContin®)
- Hydrocodone (such as Vicodin®
Among those who died from prescription opioid overdose between 1999 and 2014:
- Overdose rates were highest among people aged 25 to 54 years.
- Overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.
- Men were more likely to die from overdose, but the mortality gap between men and women is closing.
Additional Risks – Heroin Use Is Trending Up
Among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin. The increased availability, lower price, and increased purity of heroin in the US have been identified as possible contributors to rising rates of heroin use.
The Use – Deadly
Heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015. The largest increase in overdose deaths from 2014 to 2015 was for those involving synthetic opioids (other than methadone), which rose from 5,544 deaths in 2014 to 9,580 deaths in 2015. One of these synthetic opioids, illegally-made fentanyl, drove the increase. It was often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge.
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC) was quoted as saying: “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.” Furthermore he warned, “Patients given just a single course may become addicted for life.” Doctors and patients simply must become fully cognizant of this immense risk!
The Use – Costly
Addiction to opioids and heroin is now costing the U.S. more than $193 billion each year. Opiates such as oxycodone, hydrocodone, fentanyl and morphine kill more Americans than car crashes each year.
How Did All Of This Get Started In The First Place?
In the MTV production “Prescription for Change”, the struggles of drug addiction was discussed in interviews with President Obama. Furthermore, the history of opioids that led to the current addiction epidemic, was reviewed and revealed that the manufacturer of OxyContin, Purdue Pharma, lied to doctors and patients to convince them that OxyContin, a narcotic pain killer — was safe and non-addictive when prescribed for pain.
It was pointed out that beginning in1996, Purdue unleashed more than 20,000 “educational programs” to encourage long-term use of opioids to control non-cancer pain, even though there were no studies to support the use of opioids long-term in patients with non-fatal conditions.
In the first year sales of OxyContin reached $45 million. By 2000, that number had ballooned to $1.1 billion. Ten years later sales had tripled to $3.1 billion; 30 percent of the prescription opioid market.
The conclusion – The Addiction Epidemic Was Fueled by Misinformation and Ignorance.
Drug Addiction — a Crime or a Disease?
Drug addiction has long been treated as a crime. According to the U.S. Surgeon General, Dr. Vivek Murthy’s recent report on substance abuse, views are now changing. Stress is being placed on the importance of recognizing drug addiction as a chronic disease. Recently he told NPR:
“We now know from solid data that substance abuse disorders … affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones … For far too long people have thought about substance abuse disorders as a disease of choice, a character flaw or a moral failing.
We underestimated how exposure to addictive substances can lead to full blown addiction. Opioids are a good example. Now we understand that these disorders actually change the circuitry in your brain … That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness.”
Pain Education in North American Medical Schools ‘Limited’ and ‘Fragmentary’
This is clearly out of sync with the needs of Americans. So many are suffering daily with pain. Surveys show seven in 10 Americans believe pain research and management should be one of the medical community’s top priorities! Instead, it receives barely a passing mention.
What Happens When Physicians Don’t Know How to Treat Pain?
They resort to the only treatment they know: prescription drugs. This has left us to face another epidemic on top of chronic pain: prescription drug abuse. Many physicians simply do not know how to help their patients manage, or eliminate, chronic pain, and this trend is going to continue for the foreseeable future unless a radical change occurs.
Congress and health officials have criticized medical schools for failing to teach doctors about pain management, but medical schools and residency programs are moving quickly to address the issue.
“If you’re a veterinarian, you get much more training on how to address pain than if you’re a medical student,” said Nora Volkow, M.D. director of that National Institute on Drug Abuse (NIDA) in Bethesda, Md., at a Senate Hearing on pain management.
Students in veterinary schools spend five times as many education hours focused on pain management as students in medical schools. – Dr. Nora Volkow
Just 12 Hours of Pain Education in Six Years of Medical School
A study, which surveyed undergraduate medical schools in Europe, found that even when compulsory pain courses are in place, they represent just 12 hours of the six-year program – or 0.2 percent. Though the featured study took place in Europe, it echoes a similar trend identified in the US and Canada by a separate study published in The Journal of Pain.
Most of the schools offered pain education as only a part of general education courses. Less than 4 percent of the schools had a required course in pain and many offered no dedicated courses at all.
Even at those schools offering pain curriculum, the education amounted to less than five hours. Those researchers similarly concluded: most of the schools actually have no required courses on pain that all students must take. This means that 12 hours of pain study represents a best-case scenario; at 82 percent of medical schools without compulsory pain courses, the students may be receiving even less… or no pain training at all.
The researchers called for a major overhaul to address the urgent public health need to adequately manage chronic pain, including:
- The establishment of a European framework for pain education to ensure consistency in pain teaching
- The introduction of compulsory pain teaching for all undergraduate medical students in Europe
- Improved documentation of pain teaching within the undergraduate medical curriculum
Medical Colleges Take Going Forward
Association of American Medical Colleges NSews September 2016 headlined:
Medical Schools Confront Opioid Crisis with Greater Focus on Pain, Addiction Education. Some quotes:
At the University of Central Florida (UCF) College of Medicine, enhancing the curriculum to better address opioid abuse was a “no-brainer,” said Martin Klapheke, MD, Assistant Dean for medical education and professor of psychiatry.
While students already learned about pain neurology, opioid prescribing, addiction risk, and non-opioid therapies, Klapheke said the “degree of this public health crisis” has pushed the college to do more. “We didn’t have to debate this one,” said Klapheke, referring to the difficulties of fitting new lessons into an already packed curriculum. “When you realize that the majority of people using heroin began with prescription opioids, it’s a slap in the face and a wake-up call.”
- Alabama has instituted three new laws that give more medical personnel access to the state’s prescription monitoring program database, as well as tighten regulations on pain management clinics and making ‘doctor shopping’ to get multiple prescriptions punishable by jail time.
- Indiana instituted new oversight powers to the state attorney general on pain management clinics and is considering mandatory annual drug screening of people prescribed opioids.
Ending the Epidemic
At present, only 1 in 10 drug addicts receive the help they need, and those who do get into treatment typically face long wait times. About one-third of those who need treatment cannot afford it, or don’t have insurance coverage. There’s still an enormous amount of work that needs to be done to turn this epidemic around, but part of the answer is to become an educated patient, and to never fill that opioid prescription in the first place.
The drug industry and prescribing doctors must also acknowledge their role and take responsibility for its resolution. As noted in a recent video on the role of big pharma and addiction,
“We need big pharma to be honest about the products they’re selling us. We need doctors to prescribe opiates only when they’re absolutely necessary. We need to think of addiction as a treatable medical condition so people can openly ask for help, like they would for any illness.
We need to improve treatment, so it’s scientific and long-term. We need to shift money away from incarceration and into expanding treatment, so everyone has access as soon as they need it.
Every Physician Should Have an Arsenal of Non-Toxic Options for Treating Chronic Pain
According to Dr. Joseph Mercola, at the top of each doctor’s list should be an explanation of why dietary changes are so important for long-term pain relief. If you suffer from chronic pain, there’s a good chance your physician has neglected to tell you some of the ways diet influences pain.Download our list of non-opiod pain management techniques
Some suggestions for chronic pain sufferers:
- Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
- Reduce your intake of most processed foods as not only do they contain sugar and additives but most are loaded with omega-6 fats that upset your delicate omega-3:omega-6 ratio, which will contribute to inflammation, a key factor in most pain.
- Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
- Optimize your production of Vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.
Dr. Mercola further suggests once these fundamentals have been addressed the physician should be able to suggest a number of non-harmful methods to give you pain relief now, while your body rebalances and heals due to the foundational lifestyle changes you’re making. If your physician is not familiar with pain-relief techniques other than prescription drugs, it may be time to find one who is.
If you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and over-the-counter painkillers. These are the types of pain remedies that medical students should be learning about, as they provide excellent pain relief without any of the health hazards that pain medications often carry.
Download our list of alternative treatments for pain management here – Alternatives to Prescription Painkillers That Virtually Every Physician Should Know