In recent months, the opioid epidemic has dominated the news cycle in the United States, and health care providers are finding themselves at the center of these conversations.
From 2000 to 2014, the drug epidemic in the United States killed over 500,000 people, and 2014 was the most lethal year on record. The Centers for Disease Control report that more than 60% of the 28,000 deaths caused by drug overdose in 2014 were due to an opioid overdose.
Depending on the source, physicians and nurses have been accused of prescribing the medications that create dependency in patients, overprescribing prescription opioids to produce an illegal economy of diverted medications, and failing to identify patients addicted to prescription pain medications. At the same time, many health care providers have expressed tremendous interest in doing their part to address the opioid epidemic. Physicians have felt a moral obligation to manage patient pain control effectively and safely, while also decreasing the risk of abuse and diversion of prescription pain medications.
Physicians are actively seeking alternatives to opioid pain medication for the treatment of acute and chronic pain syndromes. In particular, they want to know what types of pain respond better to non-opioid treatments. For example, non-opioid modalities may be safer and more effective in treating conditions like chronic back pain and migraine headache. Professional and national guidelines for back pain and migraine headache recommend a series of non-opioid interventions for pain such as lifestyle changes, non-opioid medical management, and operative interventions. However, it is unclear if health care providers are aware of the existence of these guidelines or if they are encountering barriers to implementing them.
Physicians and other health care providers are also well-situated to prevent deaths caused by opioid overdoses. Risk factors for patients who may overdose include pre-existing liver problems, a history of opioid abuse, a history of overdose, a history of psychiatric problems, the administration of high doses of opioids, and long-acting opioids. In the immediate sense, providers should be able to accurately identify the signs and symptoms of opioid toxicity and appropriately treat patients who are overdosing with naloxone. Naloxone, the reversal agent for opioid overdose, is administered in patients who are suspected of overdose. However, this medication has a short half-life and must be re-administered every 20 minutes until the opioid has cleared the body. Increasingly, providers are encouraged to write prescriptions for naloxone for patients at risk of overdose and to teach patients, friends, and family members how to administer this medication if they suspect an overdose.
By attempting to manage acute and chronic pain through the use of non-opioid treatments, prescribing opioid medications judiciously, and learning how to reverse the effects of opioid overdose, physicians and other health care providers can do their part to combat the opioid epidemic.
 Drug Overdose Epidemic. Centers for Disease Control Web site. http://www.cdc.gov/drugoverdose/epidemic/index.html. Last Updated June 21, 2016. Accessed July 8, 2017.
Dr. V. Silverstein
Published on 7/27/17