PUTTING THE BRAKES ON OPIATE ABUSE
Nov. 30, 2012| By Dr. Nayvin Gordon
According to The Center for Disease Control (C.D.C.) 1/13/2012 , prescription drugs exceeded motor vehicle accidents as a cause of death in 2009, killing 37,485 people nationwide. These opiates (narcotics) were also responsible for approximately eight million reports of drug abuse and or dependence. Medical authorities state that “Opiates are highly addictive, and opiate dependence is a chronic relapsing condition with no known cure.” (American Family Physician, September 15, 2012 ). The California Department of Corrections reports that over 50% of inmates convicted under the “Three Strikes Law” have addiction disorders ( San Francisco Chronicle, 9/30/12 ). A Department of Public Health report on Tuolumne County , California , 5/3/12 , documents that the opiate prescription count continues to rise and that the death rate from drug overdose is 2 and ½ times the California overdose death rate. The C.D.C. , and the Executive Office of the President of the United States have labeled this reality an Epidemic.
Medical Doctors and other Health Professionals are driving their pharmaceutical trucks at over 100 miles per hour through the Public Health of our communities. Somebody must put the brakes on. There are rules for driving and we must have rules for prescribing. If the F.D.A.(Food and Drug Administration) and the D.E.A. (Drug Enforcement Agency) has no power to require and enforce, then the State and Federal Governments must step up to the plate. Washington State has recently enacted a law regarding opiate prescribing.
The majority of prescription narcotics are written for chronic non cancer pain. Treating non cancer pain with opiates is highly controversial and many pain experts, including Medical Doctors at Stanford Hospital DO NOT recommend opiates for chronic non cancer pain. This is due to dose escalation, intolerance, worsening side effects and other risks. It is documented that many of these patients have known risk factors for opiate abuse or misuse and should most appropriately be carefully evaluated and treated by Qualified Pain Specialists.
Medical Professionals must establish evidence based, best practice treatments for chronic non cancer pain. It is imperative to identify which conditions do and do not require opiates. Mandatory opiate training should be established for those who intend to prescribe opiates for chronic use. Guidelines must be established for required referral to Certified Pain Specialists. We must establish a real time database that includes all state wide pharmacies to monitor opiate usage and prescriber’s practices. Prescriber’s must be held accountable and those who violate practice standards should be disciplined. Because methadone use has been linked to 30% of overdose deaths (C.D.C. 2012), its use should be limited to Certified Pain Specialists. A red Flag alert must be set at the upper limit of opiate dosage. This daily limit should be set at 100mg of morphine sulfate equivalent. Greater amounts of opiates are associated with increasing death from overdose. (The Journal of the American Medical Association, 4/2012).
Access to healthcare including Pain specialists and Addiction Treatment Programs must be widely available. If we continue on our present path over the next few years, our Nation will witness hundreds of thousands of deaths and millions with opiate addiction disorders.
We must move quickly to put the brakes on the rapidly escalating nationwide epidemic of prescription drug related deaths and addiction.
Dr. Nayvin Gordon is a Board Certified Family Medicine Doctor. He has been practicing Family Medicine in California for over 30 years. His has worked for Medical Groups, H.M.O… Practices, Solo Practice, Social Security Disability, and is presently working at an Indian Health Center . Dr. Gordon has also written and published many articles on Health related issues over the years.
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