AN ALL-TIME record 52,404 Americans died from drug overdoses in 2015, according to the latest data released Thursday by the Centers for Disease Control and Prevention. Once rare, these avoidable deaths are now more common than auto-accident fatalities or gun-inflicted homicides and suicides. Some 80 percent of the drug-related deaths were due to misuse of opioids, a category that includes not only illicit substances such as heroin and synthetic fentanyl but also legal pain medications such as OxyContin and Vicodin, which are used for chronic pain as well as for short-term care after surgery or dental work. Indeed, the prescription opioid category accounted for the largest share of opioid deaths, at 17,536.
This must end. And a key condition for that is for doctors to become much more careful in the way they distribute these powerful pills, which are still widely prescribed for non-cancer pain, notwithstanding what is now a mountain of evidence, accumulating for years, that the drugs are far more addictive than manufacturers once led physicians and patients to believe. The CDC's latest guidelines, in fact, expressly remind doctors that opioids are not "first-line or routine therapy" for chronic non-cancer pain, and that they should be prescribed only in low dosages and small amounts, after non-opioid alternatives have been tried — and after a thorough discussion of risks and benefits.
Yet these best practices are not followed in a large minority of cases, according to a new and innovative survey of long-term opioid users by The Post and the Kaiser Family Foundation. Specifically, 38 percent of patients reported that their doctors had not even discussed alternative treatments, let alone attempted them; 35 percent said their doctors did not discuss the risk of addiction; and 30 percent said they did not even hear about side effects. Half of patients noted that they were concurrently prescribed opioids with anti-anxiety medications or anti-depressants, which the CDC also discourages. Small wonder that fully one-third of the opioid users surveyed described themselves as either addicted to or physically dependent on the drugs. And people who share a household with these long-term users (surveyed separately) have an even grimmer assessment; half of them suspect the opioid users in their homes are hooked.
Other findings in the Post/Kaiser survey lend statistical color to what was already a sad but mostly anecdotal portrait of the opioid-using population, which includes 1 out of every 20 persons aged 18 or older. Only 23 percent of them work full-time, while 30 percent are on disability — hardly support for the claim that opioids help those with chronic pain resume normal functioning. Meanwhile, 15 percent report having passed drugs they got via prescription to other family members or friends. And a shocking number of respondents (34 percent) said they sometimes used the pills “to get high,” “to relieve stress” (22 percent) or to “relax” (12 percent). For such potent, addictive medications the only acceptable percentage in each of these categories would have been “zero.” The same goes for the number of overdose deaths.
If progress is to be made on all of these fronts, American medicine must redouble its commitment to sound prescribing practices. The CDC guidelines show the way.
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