In 2012, Americans received nearly 260 million prescriptions for opiate painkillers. Now, the National Institutes of Health (NIH) has released a white paper that reports “a dire need for research” to make up for the “scant” evidence that opioid painkillers should be used to treat chronic pain.
The NIH white paper condenses the final work of a seven-member panel that was convened in September to study the place of opioids in medicine. That panel, comprising independent experts in psychiatry, epidemiology and other disciplines, wrote in its full report that “the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’.”
“The overriding question,” the panel wrote, “is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”
There is not nearly enough good research to say for sure, the experts said, writing: “Evidence is insufficient for every clinical decision that a provider needs to make about the use of opioids for chronic pain.”
That dearth of evidence combined with high numbers of substance abuse and overdose deaths in the US have created circumstances doctors need to confront immediately, the authors said.
By 2010, there were more than 160,000 hospitalizations a year for prescription opioid addiction. In 2012, healthcare providers wrote 259 million prescriptionsfor opioids, according to the Centers for Disease Control and Prevention (CDC). That year, more people aged 25 to 64 died from overdoses than car accidents.
The next year, 2013, the agency found that 71% of overdoses from prescription drugs – a total of 16,325 deaths – were caused by opioid painkillers. Last year, the CDC reported that doctors were a primary source of drugs for opioid abusers, and a doctor at the CDC estimated that 46 Americans died every day from overdoses of prescription painkillers.
Oxycodone, codeine, dilaudid and methadone are among the opiates most frequently abused; morphine is also often prescribed for patients who report extreme pain.
The new NIH white paper estimates that between five and eight million Americans take opioid painkillers to manage chronic long-term pain, but nearly all opiate drugs consumed for months and years were approved on the basis of 12-week studies.
Although people have consumed opioids to dull short-term pain for centuries, new research shows there are distinct kinds of physical pain, and that not all treatments work as effectively to manage them. The panel found that patients with chronic pain were too often “lumped into a single category”, even though humans have three distinct pain mechanisms, such as those caused by inflammation versus nerve damage or arthritis and cancer.
But experts told the panel almost unanimously that they feared physicians could not distinguish between people who were at risk or could be at risk to develop problems with misuse.
The health system itself encourages doctors to prescribe drugs, the panel noted, since many plans “nonopioid alternatives as second- or third-line options rather than placing them more appropriately as first-line therapy”.
“Important clinical tasks” have fallen by the wayside, the experts warned, in favor of seemingly easy answers such as prescriptions.
“In the case of pain management, which often requires substantial face-to-face time, quicker alternatives have become the default option.”
Ultimately, the NIH panel recommended that providers tailor treatment to each individual patient, and suggested “a multidisciplinary approach”, including a mix of physical therapy and non-drug options, “similar to that recommended for other chronic complex illnesses, such as depression, dementia, eating disorders or diabetes”.
Opioids can be very effective for some patients, the experts acknowledged, but even for those for whom the drugs work the panel recommended regular check-ups.
There is “a dire need for research on the effectiveness and safety of opioids”, the panel wrote, while also recommending an overhaul of the electronic health record system to better help doctors keep track of a patient’s medical history.
Worked with the Partnership of a Drug-Free New Jersey to create TalkNowNJ.com with some wonderful people to spread awareness on the prescription drug epidemic. I am here with from the top left Steve Adubato, Meg Dupont Parisi, Angelo Valenti, Myself and Donna Pacicco DeStefano.
Please take 15 minutes to learn about what you can do to know if someone you love is addicted to RX drugs.
The New Year always brings change for each one of us. One thing that we don’t have control over time moving on. Yet, the things that we do have control over we need to stay focused on to better ourselves and the world around us.
I haven’t posted in a while. I have been busy continuing my education. I have returned to school as a full time student and it has consumed 8 days of week of work. In order for me to make a difference in my advocacy movements, I want to gain as much education as I can. So I apologize for slacking, however will do my best in 2015!!!
Teens will be teens. They sleep late, fail a test here and there or get uncharacteristically moody. But what if these behaviors are happening more often than usual, or all at the same time? You know your teen better than anyone, but it is important to know what to look for if you suspect he or she may be abusing medicine.
Health concerns. Keep an eye out for changes in your teen’s physical health, like constricted pupils, nausea or vomiting, flushed skin or dizziness. Look further into anything that seems strange.
Changes in behavior. The signs of medicine abuse aren’t always physical. Look for changes in behavior – like sudden changes in relationships with their family or friends, anxiety, erratic mood swings or decreased motivation. It’s no secret that teens can be moody, but be on the lookout for drastic differences in the way your child behaves.
Home-related signs. If you’ve noticed belongings disappearing around the house, or found some unusual objects appearing – like straws, burnt spoons, aluminum foil or medicine bottles – this could be a sign of medicine abuse. Count – and lock up – the medicine you have in your home and safely dispose of any expired medicine.
Trouble in school. Take note of how your teen is doing in school, including any change in homework habits and grades. A rapid drop in grades, loss of interest in schoolwork and complaints from teachers could be indicators that there’s a problem.
Things just seem off. You know your child better than anyone and you know when something’s not right. Trust your gut, and talk to your teen about your concerns.
With one in four kids reporting abuse of prescription drugs in their lifetime, it’s important to take action right away if you do suspect medicine abuse. Don’t be afraid to talk – and listen – to your teen, work through things together and get help if necessary.
More than 40 addiction treatment, health care and consumer groups are urging the Food and Drug Administration (FDA) to reverse its decision to approve the prescription painkiller Zohydro ER (extended release), CNN reports.
The drug is a pure form of the painkiller hydrocodone. The FDA approved Zohydro ER in October for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Drugs such as Vicodin contain a combination of hydrocodone and other painkillers such as acetaminophen. Zohydro ER is set to become available in March, the article notes.
In December 2012, a panel of experts assembled by the FDA voted against recommending approval of Zohydro ER. The panel cited concerns over the potential for addiction.
Zohydro is designed to be released over time, and can be crushed and snorted by people seeking a strong, quick high. The opioid drug OxyContin has been reformulated to make it harder to crush or dissolve, but Zohydro does not include similar tamper-resistant features.
In a letter to FDA Commissioner Dr. Margaret Hamburg, the coalition of health groups, wrote, “In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid. Too many people have already become addicted to similar opioid medications, and too many lives have been lost.”
The health groups include the American Society of Addiction Medicine, Public Citizen Health Research Group, Phoenix House, the Hazelden Foundation, and Physicians for Responsible Opioid Prescribing.
In December, 28 attorneys general wrote to Commissioner Hamburg, saying they believe the approval of Zohydro ER “has the potential to exacerbate our nation’s prescription drug abuse epidemic because this drug will be the first hydrocodone-only opioid narcotic that is reportedly five to ten times more potent than traditional hydrocodone products, and it has no abuse-deterrent properties.”
When she was 18, Arielle would come home every day and embark on what she calls an “Easter egg hunt.” She wasn’t looking for candy. Arielle was hunting behind stairwells and inside closets in her suburban Long Island home for the OxyContin bottles her cousin brought home from work at a pharmacy and was hiding from her mother around the house.
“I found them one day, and I wanted to try them because all of my friends were already hooked,” said Arielle, who asked that her last name be withheld to avoid hurting her chances of getting a job. “I would see [my cousin] nodding out on the couch and not really being present, and that was how I wanted to feel. My best friend had just passed away, so I was numbing out the feelings.”
It took about a year before Arielle moved from prescription painkillers into the illegal drug that killed her best friend: heroin. She snorted it for the first time after tagging along with a friend who was going to buy some. “I was like, ‘I love it,'” she said. Heroin was cheaper than prescription pills — about $10 a bag, compared to $60 to $80 per pill — and gave her a more potent high.
Her friend helped her inject the drug. “It was a feeling that I don’t think anyone should experience. Because once you experience it, you want to experience it over and over again,” she said. “ Next thing I know, I’m addicted.”
Arielle landed in a Long Island jail last year after she was caught breaking into a house and stealing money to buy drugs. Now 26 and living at a substance abuse treatment center, she says she’s all too aware that her story isn’t unique.
Between 1996 and 2011, the number of people who ended up in substance abuse treatment centers in Suffolk County, where Arielle lives, as a result of heroin jumped 425 percent, according to a 2012 special grand jury report from the county’s Supreme Court. During the same period, the number of people who landed in substance abuse treatment for opioid pill use spiked 1,136 percent, the report found.
Long Island is one of many areas of the country where heroin addiction is reaching harrowing levels, according to Gregory Bunt, the medical director at Daytop Village, a New York-based substance abuse treatment center. The crisis is getting renewed attention after actor Phillip Seymour Hoffman died last month from an apparent heroin overdose. The rise in heroin use mirrors a decade-long spike in abuse of prescription opioids — painkillers that are a medical cousin to heroin, but are legal as long as they’re prescribed by a doctor.
In recent years, more prescription drug abusers have started turning to heroin for a cheaper high as the price of pills skyrockets on the black market, Bunt said. Two factors have contributed to the cost increase: opioid addiction boosting demand and doctors becoming more cautious about prescribing opioids, decreasing supply, Bunt said.
Another reason for the price increase: The Drug War, according to a January 2012 report from Radley Balko. Government crackdowns have made it difficult for even reputable doctors to prescribe pain pills. To fill the void, doctors and others looking to make a buck off the prescription pills created so-called “pill mills” — offices that prescribe pain medication in high volume and often serve people addicted to the drugs.
The result: Nearly four out of five people who recently started using heroin used prescription painkillers first, according to a 2013 study from the Center for Behavioral Health Statistics and Quality.
“A lot of people who got in trouble with the prescription opiates are switching over to heroin, and they get more for their buck, so to speak,” Bunt said. In his experience, he added, much of the heroin available today is laced with other additives, like additional painkillers — making it more dangerous.
“Once you inject the heroin that’s available today, you’re at very high risk for fatal overdose,” he said.
Infographic by Alissa Scheller for The Huffington Post
For decades, opioid painkillers, like oxycodone, hydrocodone and morphine, had been used successfully to treat conditions like intense pain at the end of life for cancer patients and acute pain after an injury like a broken bone.
But everything changed when OxyContin — and the marketing campaign that came with it — started in the 1990s, experts say. The drug, developed by Purdue Pharma, had a time-release mechanism that spaced out its effects over a longer period of time.
In dozens of seminars in ritzy hotel conference rooms across North America, the company sold doctors on the idea that the time-release function made OxyContin perfect for a population of patients who were suffering from chronic pain. Representatives also argued that the drug’s spaced-out effects made it less likely that patients would get addicted — which was the main factor deterring many physicians from prescribing opioids for chronic pain.
“This campaign focused on convincing doctors that they shouldn’t worry about addiction, so the medical community was taught to believe that addiction to opiates was relatively rare,” said Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing.
The pitch was convincing, Kolodny said, because no doctor wants to believe that they’re keeping a patient in pain unnecessarily. By 2001, OxyContin had exceeded more than $1 billion in sales, and by 2003, nearly half of the doctors prescribing OxyContin were primary care physicians, according to a 2004 report from the Government Accountability Office.
“As prescriptions began to take off, it led to an epidemic of opioid addiction,” Kolodny said. “We all became much more likely to have opioids in our homes, so it created a hazard.”
“We have now this incredibly unusual public health crisis that’s essentially caused by physicians, caused by the health care industry,” said Meldon Kahan, the medical director of substance use services at the Women’s College Hospital in Toronto.
Purdue Spokesman Raul Damas wrote in an email statement to The Huffington Post that “like any public health issue, opioid abuse is the result of many factors, not just one drug or one company.” Brand-name OxyContin represents a small share of oxycodone-based drugs on the market, and Purdue has taken steps to curb the addiction epidemic, like paying for addiction hotlines and working with law enforcement to help them better identify pills that are frequently abused.
“The recent increase in heroin abuse is an unfortunate result of many different factors, and what often gets lost is that prescription opioids play an important role in helping patients and physicians address the very real issue of chronic pain.” Damas wrote. “Purdue has led the development of abuse-deterrent opioids, but these efforts need to be complemented by public education and treatment, so that we address demand, as well as supply.”
People typically become addicted to the prescription pills in one of two ways, Kolodny said. The majority of younger users, like Arielle, find the pills lying around at home or at friends’ houses. But the other demographic suffering from prescription painkiller addiction — middle-aged Americans — typically get the pills from their doctors for things like chronic back or head pain. Once their bodies adjust, their doctors have to up the doses to mitigate the pain.
Betty Tully experienced this phenomenon firsthand. She went to her doctor in January of 2001, looking for a fix for the pain that had plagued her lower back for decades. Tully’s doctor said he had just the thing, a new “miracle drug” that could help her pain without putting her at risk of addiction. He started her on 20 milligrams of OxyContin. Soon, she was asking for more, so he upped her doses.
“By June, I was an absolute zombie. I couldn’t work anymore, I couldn’t drive my car anymore. I left my car running one day on the street,” the former real estate agent said. “I was calling his office and screaming that I needed this medicine.”
By the end of 11 months, Tully was on 280 milligrams of OxyContin per day. The mother of two, who had held down jobs since she was 12 years old, refused to leave the house for fear she’d miss a dose and go through terrible symptoms of withdrawal like nausea and profuse sweating. When she decided to get clean, it took her six years to completely get off the drug, and she says she’s lucky she was able to finally kick the habit. Indeed, according to Kolodny, “middle-aged women getting pain pills from doctors” are dying from overdoses at some of the highest rates in history. In 2010, 40 percent of U.S. drug overdose deaths were women, many of whom died from abusing prescription pills.
“I should be among those statistics,” Tully said. “There’s not many people that can take that much and be breathing every day.”
CORRECTION: Language was changed to clarify that while 40 percent of drug overdoses in 2010 were women, not all of them died from taking prescription pills.