Tuesday, January 29, 2013

Comprehensive View of the Opioid Epidemic

I ran across two great pieces of writing today, one a journal article and the other an opinion piece.  Both highlight how we got here and how hard it's going to be to dig out.  Not exactly encouraging, but as I've said before... anyone that tells you they've solve the opioid epidemic in our society should be looked upon with great skepticism.  This is hard. 

The journal article comes from the Pain Physician Journal and is titled Opioid Epidemic in the United States.  While there are no work comp specific statistics to be found, the paper is the most comprehensive overview of the opioid epidemic that I've read.  Essentially, it's a meta analysis of other studies done over the last several years.  I was left with a better appreciation of the breadth and depth of the problem at hand. 

The second piece, published this past week by Dr. Jen Gunter entitled The FDA's New Restrictions on Hydrocodone are Unlikely to Solve Any Problem, is a very honest and candid assessment of the obstacles we face as a health care system and as a society in stemming the tide of opioid abuse.  She points out the clinical, social, and financial drivers of the problem.  While the financial drivers are different in work comp, the clinical and social factors are the same.  Doctors are not sufficiently assessing depression, anxiety and other co-morbid conditions prior to the very first script.  Clinicians are not adequately exploring conservative therapies before turning to pharmacological solutions.  We know the story.

The hardest part to read was her conclusion:
"Requiring a new written prescription for hydrocodone every 30 days probably won’t change too much. Some doctors, to avoid the hassle, might refer a little sooner to pain programs (which will be good, if such a program is available) or to a surgeon (in general less good for chronic pain, but always available). Some doctors may refuse to start opioids (good for some patients and bad for others), but many doctors will probably just leave written prescriptions with their receptionists for their patients to pick up. In summary, the American problem with opioids and chronic pain will remain unchanged."

I hope she's not right, though I fear she might be.  We need more than simple restrictions on hydrocodone scripts to get this public health issue under control.

On Twitter @PRIUM1

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