America is struggling with an opioid epidemic that results in more than 130 deaths every day. This is one of the first drug epidemics we’ve had that was “generated in the health care system,” according to the National Institute on Drug Abuse. Opioids impact our country, communities, families, and healthcare professionals who are on the frontlines of dealing with those who legitimately and illegitimately want access to pain medications.
Opioids operate in two ways. They relieve pain by lowering the pain signals the body sends to the brain and they change how the brain responds to pain. They are prescribed for such things as serious injuries, postoperative care, dental procedures, cancer care, and for degenerative conditions such as rheumatoid arthritis.
Types of opioids include:
Heroin and other illegal instances
How has opioid misuse evolved and spread?
MD Daniel Ciccarone, a Principal Investigator of Heroin in Transition, a five-year study funded by the National Institute of Health, identifies 3 specific waves of drug use evolution in America.
1) Prescription painkiller epidemic Starting in the 1990s, pharmaceutical companies began heavily marketing opioids to medical practices and specifically downplaying their abuse potential. Doctors responded by prescribing more painkillers than ever before in efforts to help ease patient suffering.
2) Heroin use 2010 saw a huge rise in the use of heroin with heroin-related overdoses tripling.
3) Fentanyl and synthetic opioids Sharp increases in opioid overdose deaths have been reported since 2013 with the introduction of fentanyl into the heroin market.
How Doctors Are Impacted
Opioid prescription limits
Government and authorities have responded in varying ways to the epidemic over the years. The main way that doctors have been impacted is with limitations being placed on the amount of opioids they can prescribe to their patients.
Some doctors are frustrated that, after all their years of training and experience to assess patient pain and need, their ability to properly prescribe medication is being impeded. It is widely felt that these limits place a higher value on the issues drug addicts are going through rather than what pain patients require. Some physicians have expressed anger that bureaucrats without medical degrees are making medication decisions on patients they have never seen.
Some claim prescription limits have led to a climate of fear among doctors in balancing limitations with reducing patient suffering. Another issue doctors refer to is that some health insurance companies are using the limitation laws to inappropriately deny or delay prescriptions being fulfilled. This further leads to ridiculous amounts of administrative paperwork and doctors not being able to properly care for patients.
Continuity of Medication
Due to government opioid limits and insurance companies denying payment for certain drugs, some pharmacies are not stocking sufficient amounts of opioids. This is not clearly communicated to doctors who are prescribing legitimate opioids to pain patients. Some medical professionals indicate they have to call around to various pharmacies in a patient’s town in an attempt to locate a pharmacy that has a specific quantity of opioid for their patients. All of this leaves patients in real pain waiting, sometimes days, for a pain prescription to be fulfilled.
Doctors being jailed
A more terrifying issue doctors face as a result of the opioid epidemic is the possibility of being jailed in their attempts to care for their patients. Being jailed for overprescribing has led some physicians to give up their DEA licenses.
Leo Beletsky, an associate professor of law and health at Northeastern University, referred to the government crackdown on prescribers as “ensnaring a lot of vulnerable people who, if anything, represented minor players in a crisis that was fueled in part by the activities of major pharmaceutical firms”. Other impacts
A smaller issue healthcare facilities face as a result of the opioid crisis is the increase in break-ins and theft of sharps medical waste. At times, many facilities store their medical waste outdoors for the convenience of waste-hauler pickups. Although typically stored in a locked cabinet, the sharps container is susceptible and the generator (ie. doctor) is liable in the case of a breach or theft.
The unfortunate reality is that all too often these locked containers are targeted for their contents - syringes and potential drugs. One way around this particular situation is to utilize an onsite waste treatment option which allows sharps to be easily destroyed on-premise, with sterilized remains placed with regular office trash. (See our post on onsite waste disposal)