As opioid use disorders increase, physicians offer solutions

“The use of opioid medications to control pain is increasing because more physicians are taught to address chronic pain and be effective. With increased prescribing, there is increased misuse, nonmedical use, and suicide by opioid overdose. How to manage chronic pain as safely as possible is a daily conundrum in medical practice. There are additional methods we could use that are not yet widely known, such as “multimodal therapy.” Here is more data to consider.

The natural tendency of governing agencies writing more rules to restrict access is not useful except in denying care.  All healthcare is local, in my view. We need to do much more in each of our medical communities to address the pain maladies we see locally.” Bill Chesnut, MD

 As opioid use disorders increase, physicians offer solutions    AMA News_10/13/2015, 5:12 PM

As the opioid epidemic remains a devastating issue for patients and their families, a study published Tuesday in JAMA highlights the need to enhance access to treatment to curb the rising toll opioid use disorders are taking on the country.

The study conducted by Beth Han, MD and colleagues at the Substance Abuse and Mental Health Services Administration (SAMHSA) examines the prevalence of nonmedical use, opioid use disorders and related risk factors.

The study found that among adults age 18 through 64, the prevalence of nonmedical use of prescription opioids decreased from 5.4 percent in 2003 to 4.9 percent in 2013. Unfortunately, during the same time, the prevalence of prescription opioid use disorders increased from 0.6 percent to 0.9 percent.

The national discussion needs to center around a comprehensive public health approach that puts emphasis on treatment and education.

“Receiving treatment for substance use disorders is particularly critical,” the study states. “Most adults with prescription opioid use disorders or other substance use disorders neither receive treatment nor perceive a need for treatment. Particularly, policy and societal barriers prevent broad dissemination, access and adoption of highly effective medication-assisted therapies for people with prescription opioid use disorders.”

Another important element for addressing the epidemic is reducing the stigma surrounding substance use disorders to further promote treatment.

A second JAMA study published this week, conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, found adjusted rates for the percentage of individuals with opioid use disorders receiving treatment were low: 18.8 percent in 2004-2008, increasing only to 19.7 percent in 2009-2013.

“Individuals in treatment received care in more settings, with the greatest increases in inpatient treatment and at physicians’ offices,” the authors said, further pressing for enhanced access to treatment. But, they continued, “Medication-assisted treatments are often unavailable in inpatient settings, which could hinder patient recovery.”

How physicians are tackling the need for enhanced treatment

The AMA recently submitted testimony (log in) to Congress calling for increased coverage for and access to treatment programs. “These are complex problems with no single solution,” the testimony said.

It emphasized the need to balance the treatment needs of pain patients with efforts to curb misuse. These include promoting appropriate prescribing, reducing diversion and misuse, promoting an understanding that substance use disorders are chronic conditions that respond to treatment, and expanding access to treatment for individuals with substance use disorders.

In the battle against opioid abuse, how can physicians in direct contact with patients enhance access to treatment? The AMA Task Force to Reduce Opioid Abuse supports enhanced treatment access and is helping physicians learn how to identify patients at risk for developing a substance use disorder. The Task Force is offering resources for physicians on its Preventing Opioid Abuse Web page.

The task force has identified five important goals for physicians:

  1.  Register and use your state prescription drug monitoring program(PDMP) to check patients’ prescription histories.
  2.  Educate themselves on managing pain and promoting safe, responsible opioid prescribing.
  3.  Support overdose prevention measures, such as increased access to the overdose reversal drug naloxone.
  4.  Reduce the stigma of substance use disorder and enhance access to treatment.
  5.  Ensure patients in pain aren’t stigmatized and can receive comprehensive treatment.

US prescription opioid abuse declines, but disorders and overdose deaths rise

Reuters (10/13, Doyle) reports that a new study published in the Journal of the American Medical Association found that the number of Americans abusing prescription opioid medications declined from 5.4% to 4.9% between 2003 and 2013. However, the study also found that the rate of opioid use disorders increased from 12.7% to 16.9% and the number of prescription opioid overdose deaths increased from 4.5% to 7.8% per 100,000 people over the same timeframe. A corresponding research letter in JAMA also found that from 2004 to 2013, the use of opioid addiction treatment options did not change in proportion to the number of opioid users.