By Lynn R. Webster
As a physician and author of the forthcoming book “The Painful Truth: What We Can Do About the Largest Invisible Epidemic in America,” I hope to provide a few insights that may help as we work toward a safer world that is free of opioid abuse. Here are six steps we can take.
1. Redefine the problem. Many people who suffer from chronic pain rely on opioids to live a semblance of a normal life. There may be no alternative treatments for them. We should view the prescription opioid problem, instead, as the chronic pain problem. Many are chiming in to offer their best solutions to curbing the opioid abuse epidemic; sadly, many of the proposed solutions fail to promote and fund safer alternative therapies for people suffering from chronic pain who rely on opioids.
2. Find a plan B. More than 100 million people in the United States suffer from chronic pain. While no medical professional advocates that opioids should be the first line of defense, in some cases, they happen to be the only thing that works for a patient. Trying to end opioid abuse without addressing the needs of those who rely on the drug may make the problem of chronic pain worse. We need to come up with a Plan B.
3. Fund alternatives. In 2007, Americans spent $34 billion in out-of-pocket expenses to cover the cost of alternative forms of chronic pain treatment. To be clear, opioids are not the only means of treating chronic pain. The chronic pain community needs access to safer alternative therapies. We need to invest in research to bring even more alternative therapies to the market, and crucially, insurance companies must then cover those alternative forms of care.
4. Stop the stigma. Many patients report feeling like drug addicts for simply trying to fill their legally obtained prescriptions. We must stop stigmatizing patients who currently rely on opioids.
5. Require all opioids to be abuse-deterrent. Abuse deterrent formulations (ADF) have been shown to curb some forms of opioid abuse, while maintaining the benefits for patients that need the drug. Unfortunately, these safer formulations cost too much for practical use. The U. S. Department of Health and Human Services (HHS) should lead the way and negotiate deals with manufacturers to make ADFs no more expensive than generic alternatives to the patients.
6. Remove methadone as a “preferred” drug. While the use of methadone as an analgesic for chronic pain has expanded in recent years, it shows up in mortality reports with a higher frequency than other opioids. Despite the evident risk associated with this drug, many states have listed it as a “preferred” analgesic in treating severe chronic pain, largely due to its low cost and savings for publicly funded health plans. The American Academy of Pain Medicine holds that methadone should not be a preferred drug unless special education is provided to patients, and that it should never be the first choice in treating chronic pain.
The opioid crisis is not a black-and-white issue. Until we stop treating it as such, we will not be able to tackle the problem at its root. Millions of Americans suffer from chronic pain, but very few have access to multiple options to manage their pain.
Through increased funding and research of alternative therapies, implementation of ADF’s and greater coverage by payers, we can finally begin to treat the opioid epidemic in a safe and responsible way–a way that does not hurt the millions of Americans who rely on opioids to get through the day.
Dr. Lynn R. Webster, M.D., is a Salt Lake City, Utah-based physician, the immediate past president of the American Academy of Pain Medicine, vice president of Scientific Affairs at PRA Health Sciences, author of a forthcoming book, “The Painful Truth,” and producer of a PBS TV documentary by the same name.