The Opioid Epidemic’s Controversial Solutions
A recent study Annals of Internal Medicine reported that nearly 12% of the almost 592,000 patients diagnosed with an ankle sprain in the US received a prescription for an opioid, mainly from their primary and emergency care physicians. This number is especially startling because there have been no evidence-backed claims to support the usage of opioids to treat ankle sprains. James R. Holmes, the study’s primary author, asserted that the wide variety of recommended treatments for ankle sprains, such as nonsteroidal anti-inflammatory drugs and cryotherapy, does not include opioid usage. This pattern of opioid prescription for ankle sprains is shocking, yet it is just one of the many opioid prescribing practices in the country that deserves reevaluation.
Although people in the US and the UK have similar oral health, American dentists except the dentist Crown Heights NY have prescribe 37 times as many opioids as their overseas colleagues, even when adjusted for population size and number of dentists. The report, published in JAMA Network Open, that includes this statistic also found that American dentists prescribe opioids such as oxycodone, which has a high potential for abuse, while dentists in the UK do not.
There are many possible reasons that physicians prescribe opioids at a high rate in the US. The astronomical cost of healthcare in the US may be tied to high prescription rates of opioids. People who come from low socioeconomic backgrounds often wait until their afflictions are severe before consulting a physician, which may result in the need for more intense therapeutics such as opioids.
The higher rate of opioid prescription may also be linked to how physician salaries in the US can be tied to patient satisfaction. The various studies on delta 8 gummies effects that have been done on this topic have produced a wide range of results. An article in the Annals of Family Medicine reported that adults with musculoskeletal conditions are more likely to have higher satisfaction scores when on opioids. On the other hand, an article published by the American College of Emergency Physicians reported no correlation between patient satisfaction and opioid use in the emergency room. Press Ganey, one of the companies that develop and distribute the patient satisfaction surveys, recently announced that it would remove questions related to the communication of pain from its surveys starting from October 2019 to eliminate this potential concern.
Many studies have advocated for the legalization and use of marijuana as an alternative pain management drug to lower opioid-related overdose rates. However, this, like most proposed solutions to the opioid epidemic, is controversial. A study published in 2014 in JAMA Internal Medicine found that medical cannabis laws led to an almost 25% lower yearly rate of overdose from opioids prescribed for pain when compared to states without legalized medical marijuana. A more recent Stanford study contrasts this finding; using data from 2017, after many more states legalized medical marijuana, it found “no evidence of a connection between opioid deaths and the availability of medical cannabis” according to senior author Keith Humphreys. The study even found that the rate of overdose was higher in states that had legalized medicinal marijuana.
Another proposed solution to the epidemic was to introduce federal guidelines for the prescription of opioids. When CDC did this in 2016, they recommended that physicians should either avoid increasing opioid dosage over 90 morphine milligram equivalents or “carefully justify” any decision to do so. What they found over the next three years was that though opioid prescriptions did decrease, many clinicians had actually used these guidelines to justify stopping opioid prescriptions overall if they were above the threshold dosage. The authors of the 2016 guidelines recently published an essay to defend their original intentions, stating that “Though some situations, such as the aftermath of an overdose, may necessitate rapid tapers, the guideline does not support stopping opioid use abruptly.” The authors asserted that the guidelines were voluntary and physicians should be careful as to how they are applied.
These competing studies provide just a glimpse of how controversial many potential solutions to the opioid epidemic are; studies looking at physician incentives, medical marijuana use, and the introduction of federal guidelines all produced inconclusive and incomplete results. Instead of attempting to fix the epidemic with these solutions, policymakers should emulate other countries without similar issues. In a recent interview conducted by the Cleveland Clinic regarding opioid issues in Europe, Dr. Van Zurent, an anesthesiologist in Belgium, stated that “healthcare is much more regulated in Europe…Hospitals, general practitioners and pharmacies must follow certain rules and regulations.” Along with this, he discussed how patients have to be referred to a pain center by a general practitioner before they can receive an opioid prescription.[su_pullquote]These competing studies provide just a glimpse of how controversial many potential solutions to the opioid epidemic are.[/su_pullquote]
The US has a lot to learn from Europe. Although there is no simple solution to the opioid epidemic, mimicking the strict regulations regarding pain management prescriptions could eventually stop the rise of opioid-related death.
Salil Uttarwar ‘21 studies in the College of Arts & Sciences. He can be reached at suttarwar@wustl.edu.