A survey conducted recently by the Washington Post-Kaiser Family Foundation was one of the largest ever done on long-term prescription opioid use. A total of 809 people were interviewed. 622 of them had taken opioid painkillers for two months or more throughout the last two years. The other 187 people were living at the time with an opioid user, usually either a parent or a spouse. Nobody with a terminal illness of any kind was included.
To ensure more balanced results, 45% of those interviewed were no longer taking opioids. The other 55% still were at the time. Also, compared to the general public, long-term opioid users were “…far more apt to be middle-aged,” according to the survey’s corresponding Washington Post article.
Much was revealed as a result of the survey. For example, it seems doctors are more to blame than previously thought for the opioid epidemic. Also, the survey shows that over half of long-term users are content with their opioid status. First let’s discuss why doctors have so much responsibility when it comes to the opioid crisis. (Over 2 million Americans are addicted to legal narcotics.) Then, let’s get into the survey and discuss all of the new information it brought to light.
Are Doctors to Blame?
One-third of all people surveyed say they are addicted to opioids. This means a third “of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the powerful painkillers,” as written in the Post article. However, survey data shows that 54% of those living with a long-term opioid user believe that person to be addicted. This is logical, since naturally some addicts either deny or do not believe they are addicted.
Here’s where it seems like doctors are part of the problem.
Almost every single user surveyed “said that they were introduced to the drugs by a doctor’s prescription,” says the Post article. Furthermore, over 60% of those doctors “offered no advice on how or when to stop taking the drugs.” Further yet, 20% of them “provided insufficient information about the risk of side effects, including addiction.” All of this data becomes even more eye-opening when you realize that every year in America there are enough opioid prescriptions written to put a full bottle into every adult’s hands.
The graphic below suggests extreme inefficiency on the part of opioid-prescribing doctors. Even 22% of doctors fail to tell their patients to avoid alcohol when taking opioids. Serious changes need to be made.
Shatterproof is an organization dedicated to combating addiction in America. Their founder, Gary Mendell, perhaps asked the most important question about the survey results. Referring to how a large amount of doctors are not counseling their patients, “Why isn’t it 100 percent?” asked Mendell. “It’s unbelievable that it’s not 100 percent.” He is definitely right. It’s no secret the US is facing an opioid crisis. Heroin deaths have surpassed gunshot deaths, and last year beat 2014’s record for most opioid-caused deaths. So yes, Gary, why isn’t every doctor counseling patients?
Side Effects Lead to More Drugs
A notable section of the survey dealt with some of the common side effects of opioid use. Approximately half of long-term users experienced constipation, indigestion, dry mouth, and/or nausea. Fifteen percent of users reported breathing issues. Side effects are a well-known occurrence when taking medicine, but over 20% of those who experienced side effects took additional medication in order to treat them. 52% of users took medicine for anxiety, depression, and/or sleeplessness.
Having to take more drugs because of the drugs you take can’t be a good thing. Surely these side effects wouldn’t be so widespread if doctors were to adhere to the CDC guideline for prescribing. Plus, as we will see, a large portion of those taking opioids don’t necessarily require them medically. However, for those who do require them, opioids seem to have their benefits.
As a matter of fact, as addicted and overmedicated as we may be, and as risky as we know opioids are, those with prescriptions aren’t showing any signs of slowing down, or even wanting to.
Opioids are Working?
Whether it’s the truth or just an effect of long-term opioid use, the majority of those interviewed said that “the drugs have dramatically improved their lives,” again quoted from the Post article. Two-thirds of interviewees said the pain relief is totally worth the risk of addiction. An estimated 100 million Americans suffer from chronic pain, which is the number one symptom opioids are prescribed for.
Some things solve one problem and create new problems. Opioids are one of them.
Yes, the drugs alleviate chronic pain, and it’s likely that the majority of opioid prescriptions are written as needed. The argument is not to completely rid the market of opioids. The argument is to prescribe them safely and do everything possible to prevent subsequent opioid addiction, which kills tens of thousands every year. Also, if opioids are absolutely necessary for pain relief, there needs to be fewer pills in the bottle. Half of those interviewed in the survey said they regularly took opioids for two years or more.
Changing the Way Opioids are Prescribed
In March, the Centers for Disease Control (CDC) issued the first-ever guideline to safe opioid prescribing. “Three days or less will often be sufficient; more than seven days will rarely be needed,” says the guideline. Furthermore, the CDC has shown that beyond twelve weeks, opioids are ineffective. With hundreds of millions of prescriptions being written every year, it’s safe to say we’re an overmedicated nation.
Still, these opioid prescriptions have their place. Two-thirds of the interviewed who say the benefits outweigh the risks can’t all be wrong.
“We’re not saying that no one should ever be on these pills,” said Tom Frieden, director of the CDC. He understands the crisis perhaps better than most, given his position. Frieden simply believes that most people would be “healthier and more functional if they were off them.” The CDC guideline suggests trying any and all alternatives prior to prescribing opioids. This is because of their dangerous and addictive nature.
“The bottom line here is that prescription opiates are as addictive as heroin. They’re dangerous drugs,” Director Frieden added. “You take a few pills, you can be addicted for life. You take a few too many and you can die.” Take it from him – he directs the organization responsible for compiling data related to the disease of opioid addiction.
In follow up interviews conducted after the Post-Kaiser survey, many participants said opioids made it possible for them to live a normal life. From being able to work to simply walking, plenty of long-term users rely on opioid prescriptions. Regardless, the initial survey found several other reasons people are overmedicating. Most of them are medically unacceptable.
Why America is Overmedicating
Of the 622 actual opioid users interviewed, at least 590 people “said that they began taking the drugs to relieve pain from surgery, an injury or a chronic condition,” according to the Post article, linked again here. Less than twenty interviewees said they began as recreational users. This is overwhelming data. Remember, this does not include illicit opioid use, such as that of heroin or fentanyl. However, with 2.1 million Americans addicted to prescription pills, legal opioids have caused their own crisis.
Take a look below at some of the reasons long-term users are overmedicating themselves with opioid prescription pills. While almost all users said they take opioids to relieve physical pain, a total of 68% of users are taking them for unacceptable reasons. Logic suggests that more than the one-third of participants who admitted to having an addiction actually have one.
The more information the survey uncovered, the more it became clear that there is a major conflict here. While opioid addiction is tearing our country apart, very many people need opioids to function, it seems. According to the survey, over 80% of users tried to use nonnarcotic meds to manage their pain, and nearly 70% of users tried alternative treatment, such as therapy or acupuncture. Of all those who tried something other than opioids, 57% found it ineffective.
This begs the question of whether or not alternative forms of treatment have been fully explored. If not, it’s time for more effort. Either way, it’s definitely much easier said than done. Almost 60% of long-term opioid users have taken four prescriptions at a time, and about 33% have taken seven at a time. Who’s to know what works for whom?
A Tale of Two Addictions
Tale 1) For two years and counting, Charles Stonesifer of Maryland has been taking a combination of Tylenol with codeine and Tramadol, a relatively strong opioid painkiller. Charles is a seventy-four year old bricklayer, who says both of his knees are “shot.” He gave opioids up, aware of the dangers, but “was forced to resume taking them” once his pain returned, as stated in the Post article. Without the pills, he says he can’t even walk.
Tale 2) For fifteen years and counting, Nancy Horton of West Virginia has been taking 190 milligrams of oxycodone every day. She is a sixty-two year old suffering from rheumatoid arthritis. Nancy fully admits to being an addict. She says without the opioid, “I get the shakes. I am very anxious. I just pace constantly. I can’t get comfortable. I look back now and think, ‘What could I have done differently?’”
These are true tales that show how difficult the opioid situation truly is. Still, some major changes have to happen in the way of how doctors prescribe opioids.
Ending the Debate
The only way to solve the mystery of opioid prescription is to crack down on the actual prescription process. A letter from Surgeon General Vivek Murthy was sent to every single prescribing doctor in America at the end of August this year. In it, Murthy pleads with the doctors, reminding them that “Americans are dying each year by the tens of thousands from overdoses of prescription painkillers such as OxyContin and Vicodin.”
The letter was the first of its kind, and a precursor to the Surgeon General Report on Alcohol, Drugs, and Health. Also the first of its kind, the report asks the American public to change their perception of drug addiction, from one of scorn to one of understanding. Regarding the prescription pill crisis, Surgeon General Murthy says, “It is important to recognize that we arrived at this place on a path paved with good intentions.”
Now it’s time to take a few steps back on that path, and correct the way we treat pain. Doctors must also take greater steps toward safe practice. Perhaps due to a lack of sufficient counseling, one out of every six long-term opioid users has mixed alcohol into the equation.
Five percent of Americans aged eighteen and over “have used prescription opioids for at least two months,” as stated in the Post article. Of these approximately 1,200,000 people, nearly 600,000 have taken opioids for two years or longer. When the CDC tells us to take them for seven days max, something is obviously wrong. It does not matter whether it’s doctors to blame, for over-prescribing and under-counseling, or it’s users to blame, training their bodies and minds to not be able to function without opioids. What matters is fixing the problem.