Back in 2013, we published a close look at the rising opioid crisis. It focuses on the likely impact on access to pain medication for those who truly need it. In short, it was clear that regulations would tighten in response to addictions sweeping regions and increasing death rates. At the time, we predicted that general practitioners would see limits on their ability to prescribe opioids, that more and more patients would be referred to pain specialists, and that these specialists would be using preventative measures and intrusive observations to try to ensure compliant opioid use.
Since then, the crisis has only gotten more pronounced. Health professionals, politicians, and social programs are all involved in solving the problems associated with heavy reliance on opioid medications for chronic pain management and the prevalence of abuse surrounding these medications. Let’s take a closer look at what has happened in the past five years. This article covers how the management of opioid use has changed and what impact these regulations have had on the people who truly need the medication.
A Look at the Stats
The CDC’s latest Drug Overdose Death Data report shows significant increases in drug overdose deaths across virtually the entire eastern United States. Opioids were involved in 42,249 deaths, a number five times higher than it was in 1999.
Even more recent reporting from the CDC indicates that there are few signs of alleviation of the opioid crisis. An analysis of emergency department data from multiple states indicates a 30% overall increase in opioid-related emergency room visits from July 2016 through September 2017.
Public awareness of the issue has also increased in the past few years. In 2016, President Obama declared September 18-24 to be Heroin and Opioid Awareness Week, a declaration that was accompanied by a series of town hall meetings and presentations aimed at finding solutions and implementing preventative measures.
President Trump, likewise, has made the opioid crisis a key part of his platform. In October of 2017, he declared the opioid epidemic to be a public health emergency, with experts noting that opioid addiction was claiming up to 140 American lives a day. Although, President Trump’s most recent response to the opioid epidemic has focused primarily on law enforcement and criminal justice remedies, vowing in his most recent State of the Union address to get “really, really tough, really mean with the drug pushers and the drug dealers.”
Regulations and Preventative Efforts
The crisis has hit such high proportions that the FDA is openly admitting upcoming regulations will likely be “uncomfortable” for the drug companies who produce these medications. Additionally, proposed and ongoing regulations impact everyone from manufacturers to health providers to patients.
- Packaging Regulations- While not yet enforced, the FDA has expressed an interest in smaller packages of opioids. They are even considering single-dose packaging of drugs like Percocet and Vicodin. Thus, these could be given to patients in need of immediate pain relief, which promotes alternative treatment and follow-up appointments for ongoing pain management.
- Databases- For some time, 49 states have had databases to monitor prescription drug usage. This tool allows pharmacists to monitor for potentially illegal activity and step in to curb abuse. Missouri was the sole holdout, but that state’s governor, frustrated with the lack of any legislative movement on the issue, created a database via executive order in 2017 that has been up and running for a few months.
- Provider Guidelines- In 2016, the CDC updated their recommendations for prescribing opioid medications. Their recommendations include a preference for non-opioid treatment options, including non-pharmacological options like cognitive behavioral therapy. Also, they recommend the use of drug testing before prescribing medication. Testing ensures that the patient is not already receiving opioid medications from another source. Providers are also encouraged to follow up after initial care within 1 to 4 weeks and every 3 months thereafter. These guidelines are Category A, which refers to all patients outside of post-cancer care, palliative care, and end-of-life care. Category A includes those with chronic pain.
Alternatives and Impact on Patients
The impact of these regulations and overall public health awareness surrounding the opioid crisis has been substantial. Many chronic pain patients fear what new regulations will mean for their daily pain management. Indeed, stricter regulation could eliminate their access to medications that make their lives bearable and allow them to be functional on a daily basis.
Providers, public health advocates, and legislators look for solutions to the opioid epidemic. For example, these include several alternative treatment options.
- Non-pharmacological Alternatives- For ongoing issues like chronic back pain and arthritis, many professionals are now focusing on drug-free options. These include exercises, meditation, and cognitive behavioral therapy. They are also encouraging people to rethink the concept of pain. This entails accepting some daily pain as a way to avoid the potential risks of opioid treatments. As Dr. Muhamad Farhan explained in an NPR article on the subject, “our idea of being completely pain-free can lead us to more pain and a lower quality of life.” Therefore, he starts his treatment by adjusting patients’ expectations of a pain-free life.
- Non-Opioid Medications- There have been some promising suggestions that medical cannabis could alleviate the need for opioid-based prescriptions. States with legal medical marijuana have seen decreases in the use of opioids. Furthermore, patients report far fewer side effects from this treatment option.
Many of the CDC recommendations note several alternatives to opioid medications for acute pain. However, there are few effective alternative options for those suffering from chronic pain that will ensure a pain-free life. There has been some promising research that suggests access to medical cannabis reduces the need for opioid medications. Although, these treatments are not an option for all patients due to state regulations and provider preferences.
Contact Us Today
The opioid crisis often focuses on the impact to addicts and those who abuse prescription medications. Yet, the narrative leaves out those who depend on these treatment options to lead fulfilling lives. Medical research cannot provide truly comparable alternatives that allow chronic pain sufferers the relief that they need. Thus, any opioid regulations need to take their needs into account and adjust for them. Those who are using the medication as intended and as prescribed should not be made to suffer the consequences brought on by those who are abusing the medication and breaking the law.
Hopefully, research into alternative treatments and efforts to curb illegal abuse of opioids will continue to be a primary focus for those who are committed to addressing this crisis. Hanagan and McGovern will continue to stand by those who have suffered from injuries that leave them with debilitating pain, with the belief that these patients deserve effective treatments that will alleviate their suffering.
Hanagan & McGovern is a Mt. Vernon, Illinois, workers’ compensation and personal injury law firm serving southern and central Illinois. If you have questions concerning this article or have other workers compensation questions, please contact us.
CDC “Drug Overdose Death Data” https://www.cdc.gov/drugoverdose/data/statedeaths.html
CDC “Emergency Department Data Show Rapid Increases in Opioid Oversodes” https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html
Department of Justice Archives- https://www.justice.gov/archives/opioidawareness/heroin-opioid-awareness-week
“Trump Administration Declares Opioid Crisis a Public Health Emergency” https://www.npr.org/2017/10/26/560083795/president-trump-may-declare-opioid-epidemic-national-emergency
“Trump Says He Will Focus on Opioid Law Enforcement, Not Treatment” https://www.npr.org/sections/health-shots/2018/02/07/584059938/trump-says-he-will-focus-on-opioid-law-enforcement-not-treatment
“FDA Commissioner Warns Drug Companies of ‘Disruptive’ Regulations to Fight Opioid Epidemic” https://www.cnbc.com/2017/11/02/fda-chief-may-need-disruptive-regulations-to-fight-opioid-epidemic.html
“FDA Explores Single-Dose Packaging to Reduce Opioid Abuse” https://www.ada.org/en/publications/ada-news/2018-archive/january/fda-recommends-single-dose-packaging-to-reduce-opioids-addiction
“Missouri’s Version of Long-Awaited Prescription Monitoring Program is Up and Running” http://www.stltoday.com/news/local/govt-and-politics/missouri-s-version-of-long-awaited-prescription-monitoring-program-is/article_082eaa5c-a898-5510-9158-557a2bef144c.html
“CDC Guidelines for Prescribing Opioids for Chronic Pain” https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm#B1_down
“Opioids Don’t Beat Other Medications for Chronic Pain” https://www.npr.org/sections/health-shots/2018/03/06/590837914/opioids-dont-beat-other-medications-for-chronic-pain
“New Studies Show that Legal Cannabis Access Reduces Opioid Abuse” http://thehill.com/opinion/healthcare/376643-new-studies-show-that-legal-cannabis-access-reduces-opioid-abuse