Physician’s Role in The Opioid Epidemic

Christopher was a great student and a star athlete. One day, he got in a car wreck, which left him with minor back pain that remained after the car crash. Because of this back pain, he was prescribed opioids to help with the pain. Christopher grew to like the way he felt after taking the medicine, and so he naturally searched for another physician that would be willing to write him a larger quantity prescription. He went from taking one pill a day to twenty-five. With medication abuse, Christopher’s entire attitude towards everything changed. He fought with the people he loved, he could not sleep at night, and he would rarely come home for the night. After being admitted to multiple rehabilitation centers and being kicked out due to his poor behavior, his addiction only got worse from there. After two years since his accident, he passed. He was only twenty-two years old, and it all started because of some minor back pain.

Today there have been an increasing amount of deaths due to the great number of opioids that are available to today’s society. Opioids are a form of pain relievers that can produce euphoria, which is the feeling of happiness or pleasure that leaves one in a more relaxed state. With the feeling of this euphoria mixed with the pain, patients can misuse this drug very easily because they enjoy the feeling that results from the medicine. An individual can take the prescribed medication in ways they are not supposed to such as via needle or they can take more of the medication in one sitting than they are supposed to. The real danger of the medicine is that even when one takes it properly, the medicine can lead to dependence. When someone is depended on a medicine, and they then misuse the medication, it can lead to worse happenings such as addiction, overdose, and even deaths.

This issue affects all types of communities across America. It does not matter the race, age, or socio-economic standing – this epidemic is wiping them all out. According to AAMC News, the Centers for Disease Control and Prevention estimate that on average ninety-one Americans die a day from the improper use of opioids. Whether a patient comes in with a torn ACL or if a patient comes in with back pain, they are often given a prescription to some type of pain medication. While these medicines are a vital tool in treating their patients that are in pain, they have a major risk in misuse.

The issue that will be addressed in this paper is the role that the medical practitioners play in fueling the opioid epidemic. Some people will blame the individual patient, but others will blame the medical figure. Here is another shocking statistic from the Centers for Disease Control and Prevention: from the year of 2000 to the year of 2014, nearly half a million Americans have died from drug overdoses. An even more terrifying statistic is that from 1999 to 2017 almost 400,000 people have died due to an opioid overdose specifically. Because of the terrifying statistics, the opioid crisis is crowned as the most extreme public health emergency to this day.

I chose this topic specifically because I am planning a career in the medical field, as well as the fact that I personally know someone who had overdosed on heroin. After a friend of mine had overdosed a couple years ago, it not only opened my eyes, but the entire city. I do not think that people that are in high school or college are truly aware of how easily it is to become a victim of the opioid epidemic.

With this issue being so complex, it is going to a huge amount of creativity to put an end to it. Since currently any medical practitioner can write a prescription for these medications, my plan is to take two courses of action. This issue is not only a national issue, but a worldwide one. There have been dramatic increases in Australia, China, Europe, and Russia. First, I would make it a requirement that any type of medical practitioner needs to partake in an annual recertification to make sure that they are up to date on the current information on the opioids and their effects. Second, I would make it a law that only certain specialist could write prescriptions for opioids. For example, a neurologist will not be allowed to write this script, but a pain specialist can write the script if they are up to date and have been recertified. By doing these two things, my hope would be that there will be fewer of these potentially lethal medicines just lying around and there will be fewer deaths.

Back in the 1980s, there was no fear of patients becoming addicted. Physician’s prescribed these medicines without the fear that their patient would later end up becoming addicted and/or overdosing and killing themselves. Russell Portenoy, MD, neurologist and pain specialist who was also the Chairman of Pain Medicine and Palliative Care at Beth Israel Hospital in New York, stated that the risk of addiction was so small that if a physician did not treat their patients’ pain then it was said to be considered cruel. It could also even be considered as medical negligence. Today, when a nurse enters a patient’s room, they more times often than not ask for the patient’s pain level to then report that response back to the patient’s physician. Practicing physicians tend to prescribe these potentially lethal medications to ease their pain. A doctor, for obvious reasons, does not want to see their patients in pain, so they think the solution is give the patient access to narcotics to make the pain go away.

Overprescribing

A huge factor that contributes to the opioid epidemic is the fact that these medicines are being overprescribed. While this is not the sole cause of the problem, it is a huge contributing factor. When patients are prescribed more medicines than they really need, then this can lead to them becoming more dependent on the medication. This dependency can lead to more serious issues such as overusing and even death. Back in the 1990s, pharmaceutical companies were convinced that opioids did not have an addictive effect, and that there was no chance that patients would become addicted. They were obviously wrong. With that being said and with that knowledge, medical practitioners did not see the problem with prescribing these medicines as well as giving a little extra, so their patient had the supply if they needed it. Medical practitioners’ goal, for obvious reasons, was to make sure their patient was happy and pain free.

The patient themselves are very smart, and they know how to acquire more medicine than what they were originally given. Patients can see multiple doctors for the same issue, and all the doctors could be writing the same script. This gives the patient access to more than what they need for their diagnosis. Communication is key. If the entire medical world used the same program for sending in prescriptions, then they would be on the same page about their patients. All the patient’s history regarding family history and prescription history would all be in the same place. If this happened, then medical practitioners would already see that John Doe was prescribed that medicine last week, and that he/she cannot have another refill until a later set date.

Too Many

The fact that these medical practitioners overprescribe these medicines leads me to my next point, which is that there are so many extras lying around. Recent studies have shown that with the nine billion Vicodin that was prescribed last year, it is estimated that half of that medication is lying around unused. With having so many left over, people are dealing them across the nation. With this being said, pharmacies should have a place where patients could return their unused medicines. This solves the issue of extras lying around unused, as well as solving the issue about people overusing the pill as well.

As stated before, it should be a law that a practicing medical professional must only be allowed to write a prescription for an opioid if they obtain a certain specialty license or if they are not recertified to ensure that they are up to date on the drug. For example, a dentist should not be allowed to write these since it does not exactly fall under their expertise. On the other hand, a pain specialist should be allowed to write these medication scripts since they are specialized in that subject. Anyone that is currently practicing in pain management, anesthesiology, physical medicine, or rehabilitation should be able to write these prescriptions since they are specially trained. If a dentist thinks that a pain medication would benefit the patient, then they should have to consult with a pain management physician to ensure that that is necessary.

Medical Schools’ Ranks

A huge issue that was discovered regarding this epidemic was medical schools’ individual rank. It was observed that medical practitioners who studied at higher ranked medical schools write fewer scripts for opioids. In contrast, medical practitioners who attended lower ranked medical schools are found writing opioid prescriptions more often. According to an article from the National Bureau of Economic Research, physicians who attended the lowest ranked US medical schools prescribe nearly three times as many opioids per year as physicians who attended the top medical schools in the US. This bureau also states that of every medical practitioner prescribed like those who studied at the higher ranked medical schools, then the United States “would have had 56.5% fewer opioid prescriptions” and even better, “8.5% fewer deaths” from the year 2006 to the year 2014. In 2006 there were a total of about “2.04 million” opioid prescriptions written. Six years later in the year of 2012 that number jumped to “2.6 million”. This is an even more alarming statistic; in the year of 2014, on average, a physician wrote “221.7 opioid prescriptions”. With taking in all these statistics, that leaves only “28.3% of physicians not writing any opioid prescriptions” in the year of 2014.

Medical Schools’ Cirricula

The last issue that I would like to address in this paper is regarding the medical schools’ curricula. In some states, such as Massachusetts, there are some reported medical schools where they do not make it a point in their curricula to teach the safe way to prescribe opioids. In fact, in 2016, medical schools were asked to take a pledge by the White House to implement new guidelines brought by the Center for Disease Control regarding prescribing specifically opioids.

Summary

Remember Christopher from the first paragraph of this paper? From reading this paper, the audience should understand how that young man who only had minor back pain ended up dead. Medical practitioners play a huge role in the opioid epidemic but tend to stay more behind the scenes. Our society today believes that this epidemic has sprouted due to the uneducated, more recent generation. The ones who attended medical school should be passing along the education to this young society. Medical professionals’ characteristics reflect immensely on their professional choices- more specifically, when it comes to writing a potentially dangerous prescription. A huge factor that plays a role in this unfortunate epidemic in time is where they went to medical school. If we look back at the statistics above in this paper, we notice the obvious difference in medical practitioners who studied at a higher ranked medical school versus a medical practitioner who studied at a lower ranked medical school. This is going to be a gradual change, but with this change, our society should have a lower death rate.

Works Cited

1. Ann Marie | Rx Awareness | CDC Injury Center. (n.d.). Retrieved from https://www.cdc.gov/rxawareness/stories/annmarie.html
2. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use | NEJM. (n.d.). Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMsa1610524
3. Opioid Overdose. (2018, December 19). Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
4. Schnell, Molly, Currie, & Janet. (2017, August 03). Addressing the Opioid Epidemic: Is There a Role for Physician Education? Retrieved from https://www.nber.org/papers/w23645