By Victoria Allen
Last month, the White House finally declared America’s opioid epidemic a national public health emergency. With more than 64,000 Americans dying in 2016 from drug overdoses, a majority involving prescription painkillers and illicit opioids like heroin, this is a public health emergency long in the making.
While many of us and our communities have been affected for years by this crisis, the White House revealed Nov. 19, that the financial cost of the opioid epidemic has been grossly underestimated. The White House’s report found the true cost of the opioid drug epidemic was $504 billion in 2015 alone. With the end of 2017 in sight, the estimated financial impact is well beyond 2015’s half-trillion dollars, and it’s not decreasing as more and more people in our communities become addicted to opioids every day.
As a practicing primary care doctor in Seattle for more than 25 years, one of the most difficult illnesses I deal with is addiction. Addiction, especially opioid and prescription painkillers, is a public health crisis that the entire medical community, as well as our regional, state and federal governmental bodies, must fight. Regulatory agencies and big pharmaceutical companies must take accountability and prioritize the public’s health over profits.
When I was in medical school in the 1980s, I learned that opioid medications were known to be powerful and addictive. As a young physician I learned to be very careful prescribing any narcotic medications to patients. But in the 1990s, the narrative regarding opioid prescribing practices significantly changed. Doctors were told that we were undertreating pain. Drug companies began to develop and sell new, “safe” opioid medications that were marketed as far less addictive, and thus meant to be prescribed for the treatment of all types of pain. We were encouraged to prescribe these medications using pain as the “fifth vital sign.”
By the early 2000s opioid addiction was on the rise in America — as was the rate of overdose deaths. An epidemic was occurring, the majority of which was rooted in addiction to prescription pain medication. Over-prescribing by doctors was the root of the problem.
In response, emphasis was placed on educating physicians about the risk of prescribing these medications. Safe prescribing guidelines were developed as a framework to aid physicians in the appropriate uses for opioids.
The medical community has taken responsibility for contributing to the creation of the opioid epidemic in our country. We have been working hard to change our prescribing patterns, which peaked in 2010, and seen yearly reductions in the number of pain medication prescriptions written by physicians.
Yet, despite this change in physician behavior, the opioid epidemic continues to worsen. More people are addicted. Overdose deaths continue to rise and is now a leading cause of death for Americans under 50.
The powerful influence of pharmaceutical companies and drug distribution companies on our federal government plays a huge role. Their influence is so strong, they enabled legislation that disabled the DEA from pursuing the grossly inappropriate distribution of opioid medications throughout our country. The Ensuring Patient Access and Effective Drug Enforcement Act has allowed illegitimate prescribers and pharmacies — known as “pill mills” — to distribute massive quantities of prescription drugs throughout our country without any physician involvement.
As someone who sees patients battle addiction every day, this disclosure was shocking beyond my comprehension. It suddenly became clear what a tiny fraction of this enormous problem was accounted for by the behavior of licensed physicians. Misguided legislation is why the opioid epidemic continues to worsen despite public, patient and physician education and changes in our prescribing patterns. Congress has effectively disabled the most powerful body with the ability to regulate drug crises in our country — the Drug Enforcement Agency — from stopping the huge flow of these medications into our communities.
With this devastating revelation about the deadly grip that pharmaceutical companies, drug distribution companies and major pharmacy chains have on our government and our country I was tempted to give up. However, I have realized that this battle is larger than just the medical community responsibility: We all must fight it.
It is not simply a matter of changing how doctors prescribe drugs; beyond that, we must all call upon our elected representatives to pass legislation to again regulate the production, distribution and use of this potent class of drugs. It will take all of us working together with our legislators to conquer the opioid epidemic.
So, let’s get to work. Many lives depend on it.
Dr. Victoria Allen is the medical director at Pacific Medical Centers Beacon Hill Clinic in Seattle and the current chairman of the board for Recovery Cafe in Seattle.