Response to opioid epidemic misguided

Posted 12/12/19

A study published last month in the peer-reviewed journal Annals of Emergency Medicine followed 484 “opioid naive” patients prescribed opioids for acute pain upon release from the …

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Response to opioid epidemic misguided


A study published last month in the peer-reviewed journal Annals of Emergency Medicine followed 484 “opioid naive” patients prescribed opioids for acute pain upon release from the emergency department. Opioid naive patients are basically defined as those not chronically receiving opioid drugs on a daily basis.

Only 1 percent, five patients, met the criteria for persistent opioid use by the end of a six-month period following their release, and all but one of those five reported they still had moderate or severe pain.

A 2017 study published in BMJ, a leading medical journal, found the total rate of misuse among 568,000 patients prescribed opioid drugs for acute postoperative pain between 2008 and 2016 was a mere 0.6 percent.

Research consistently fails to find any correlation between opioid prescriptions and non-medical use of these addictive drugs. State-to-state analyses have also failed to find any correlation between overdose rates in the state and the state’s opioid prescription rates.

There is an epidemic of opioid abuse, but like so many other societal problems, panic is driving misguided responses that not only fail to address the problem, but also create more problems.

The Wyoming Legislature passed a law last session that limits prescriptions for acute pain to opioid naive patients, to no more than a seven-day supply in a seven day period. These hard limits followed the mistaken belief that legal prescriptions are connected to overdoses and abuse.

Other states have passed their own laws, many of them in line with the 2016 CDC guidelines for prescribing opioids for chronic pain. Zealous applications of the guidelines ended up risking patient health and safety. Patients who were suffering from chronic pain were left in debilitating agony when they were either underprescibed pain medications or had their prescriptions suddenly reduced.

In April 2018, the Centers for Medicare & Medicaid Services noted, in response to another proposed rule that might have restricted opioid prescriptions, physicians were opposed to forcible dose restrictions due to the adverse effects it could have on patients. The CMS also stated that patients with chronic pain who have been functioning well on opioids for years lived in fear of disruptions to their opioid pain management, which resulted in extremely adverse outcomes, including depression, loss of function, quality of life, and suicide.

This past April, the authors of the 2016 CDC guidelines provided further clarification to help alleviate the misapplication of the original guidelines. The new guidelines warned that hard limits or “cutting off” opioids should be avoided for the health and safety of those in need of pain management.

State and federal laws responding to the opioid abuse epidemic are targeting prescriptions on the mistaken belief the problem begins there. Research is showing this just isn’t the case, and so these laws are not likely to have any impact on the problem.

Rather than targeting legally prescribed pain medications, lawmakers should focus on expanding substance abuse treatment, which is shown to have an impact on reducing drug abuse.

Following the passage of opioid-related bills last session, Rep. Albert Sommers, R-Pinedale, who is on the Joint Opioid Addiction Task Force, told the Wyoming Tribune Eagle they’d concentrate on substance abuse treatment this year. They probably should have started there in the first place, but hopefully this session the commitment to funding treatment doesn’t get forgotten.