In the struggle against the opioid epidemic in the United States, any positive news is welcome.
The crisis is acute: the last report from the Department of Health and Human Services, in 2014, found that more people died from drug overdoses that year than ever before. Opioids, the synthetic compounds that mimic the function of naturally occurring opiates in minimizing pain, have been a preferred tool in pain management since the 1990s. After two decades of opioid development by pharmaceutical companies and wide prescribing by physicians, though, opioids are implicated in some 60 percent of those drug overdose deaths, and have wreaked havoc on more and more lives through addiction and conditions such as opioid hyperalgesia.
Sturdy traditional approaches like drug abuse intervention and addiction counseling are our front-line resources, turning the tide of opioid abuse individual by individual. The positive news in the battle against opioid misuse is that technologies such as predictive analytics are emerging as useful complements to these essential approaches.
Origins of the crisis
The current opioid crisis is so dismaying in part because it can be traced to well-intentioned changes in health care, specifically those changes in pain medicine in the 1980s and 90s.
At that time, physicians began to understand pain as a medically meaningful aspect of a patient's condition. This new importance of pain, which by some came to be called the "fifth vital sign," led to pharmaceutical advancements in pain medicine, including the development of new opioids. In the same way that opiates (derivatives of opium) act on pain receptors to minimize the experience of pain, these time-release synthetic drugs block the pain signals by occupying the pain receptors. While they do minimize pain effectively, they are powerful substances that we now know often lead to personality and mood changes, addiction and attendant complications.
Wide damage, deep impact
The United States accounts for 5% of the world's population but is probably responsible for 80% to 85% of opioid use worldwide. Zooming in to a single state, Tennessee, a 2014 report found that for each of the state's 1263 deaths attributable to opioid overdose, there are 851 people in various stages of misuse, abuse and treatment. In other words, 1 in 6 of the state's residents is associated with opioid addiction.
The damage to an individual's personality, productivity and focus is devastating; the effect on their family and loved ones is equally profound. Beyond this emotional harm, the greater numbers of opioids in circulation are leading to more prescription drugs available on the street. The stream of people addicted to painkillers also means that many will at some point seek out a cheaper option. Heroin is typically the option of choice as single "hit" of heroin costs around $15 (as opposed to a single OxyContin pill, which can cost between $50 and $80 on the street).
Even people who don't turn to heroin often grapple with dependency. Under attentive physician guidance, people can still develop opioid hyperalgesia, a condition where opioid use leads to day-to-day activity becoming painful.
At the national level, the massive cost of treatment and rehabilitation looms large. Some of these costs will be borne by businesses that are already suffering losses to workplace productivity due to opioid misuse. A 2007 study concluded that opioid abuse cost employers more than $25 billion in a single year. Associated issues include absenteeism, disability and safety problems. Additionally, people struggling with opioid addiction are more likely to use workers' compensation benefits.
Systemic solutions
American governmental institutions and regulatory bodies are responding to the crisis with some much-needed legislative force. Congress recently passed the Comprehensive Addiction and Recovery Act, which some believe to be landmark legislation for dealing with the epidemic. Bodies like the Centers for Disease Control are also attacking the crisis at its origins, seeking to decrease the reliance on opioid prescription in specific medical specialties. The most effective way to combat opioid addiction, of course, is to not prescribe opioids in the first place. For chronic pain, non-opioid therapy is now preferred (except in active cancer, palliative, or end-of-life care). There is increasing pressure to prescribe the lowest possible effective dose, which should also help. Finally, physicians are at last being instructed about what a potentially life-altering decision the prescription of opioids can be.
Promising developments
Predictive analytics promises to help populations get ahead of the crisis through proactive management, timely education and better-targeted interventions.
As a healthcare system and as a nation, we've taken some smart steps recently, but we still need to do more. Addiction medicine specialists will be an important part of the solution, and family physicians and local agencies can help in providing referrals. Health management organizations too can play a role in proactive management and counseling, but such efforts are most successful when they engage individuals on an intimate and personal level. The move toward highly qualified, experienced and knowledgeable physician care guides is a very positive development in this direction. These resources are able to work with employers, individuals, and their medical team to provide informed guidance, promising to save grief, lives and economic loss that everyone pays for.
Part two of this two-part series will explore the physician care guide model in more depth, exploring how data informs but does not dictate the guidance they offer to individuals.
Big data can help us understand and chart public health issues like the opioid crisis. But individuals struggling with pain and addiction must be listened to and treated one by one.
About the author
David L. Brown, MD, is the founder of Curadux, where he leads experienced physician Care Guides in providing 24/7 decision support and advocacy for clients (individuals and employer-referred) and their families facing chronic or advanced illness, including opioid misuse. Prior to founding Curadux, Brown practiced medicine for 38 years and chaired the departments of anesthesiology and pain medicine at the Cleveland Clinic, University of Texas – M.D. Anderson Cancer Center, the University of Iowa Hospital and Clinics, and the Virginia Mason Medical Center, as well as serving as professor of anesthesiology at the Mayo Clinic.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.