Finding balance in the opioid epidemic: The FDA, patients, and physicians weigh in

116 daily deaths, 42,249 yearly deaths, and $504 billion were the statistics that haunted Americans as a result of the opioid epidemic in 2016, according to the U.S. Department of Health and Human Services.

While the opioid epidemic has taken a physical and financial toll on Americans for decades, the effects of this crisis have increasingly become clear in recent years. With a 30% increase in opioid related overdoses last year alone, regulators, hospitals, and physicians alike have been trying to actively manage and thwart this growing public health crisis.

As the epidemic continues to be a hot topic for the current administration, the FDA recently held a public meeting on patient-focused drug development for chronic pain in order to gain the perspective of patients suffering from pain that is managed with analgesic medications such as opioids. Prior to the meeting, FDA Commissioner Scott Gottlieb shared, “There are still too many prescriptions being written for opioids…that aren’t appropriate for the medical need for which the opioid is prescribed…While we work to ensure appropriate and rational prescribing of opioids, we won’t lose sight of the needs of Americans living with serious chronic pain or coping with pain at the end of life.”

As the FDA aggressively confronts this national scale, it’s high time that the public considers the nuance of the challenges doctors face in light of the epidemic. While careless prescribing practices are often viewed as the root of the epidemic, the origin truly resides in Pain – an ambiguous concept that is subjective to each patient. Pro-patient policies, such as “pain as the 5th vital sign”, have fostered the epidemic. When a patient’s verbal “prescription” of their own pain outweighs the medical knowledge of physicians, definitive prescribing practices become unclear. "As a physician, we took an oath to do the best for our patients,” said Dr. Linda Girgis MD, FAAFP, a practicing family physician in South River, New Jersey. “But with the opioid crisis, it is often hard to determine what is best. Many patients who request opioids do so for non-medical reasons. However, many patients with real pain are being neglected in this crisis and having a hard time having their pain treated appropriately. Doctors are often in the position of deciding if it is more harm to treat pain in a patient who may not need it versus leaving pain untreated in a patient who does.”

Although few alternatives to opioids exist, 61% of physicians disagree with the FDA’s decision to approve high-dose opioid analgesics, according to SERMO, a private social network for physicians. “Higher dose opioids are just another alternative in the medications that fuel the crisis,” said Dr. Girgis. “We need to call on pharmaceutical companies to develop new, effective, non-addicting pain medications and for insurance companies to do a better job covering services such as physical therapy and alternative treatment options.”

Although 50% of doctors have stopped prescribing opioid medication in response to the epidemic, the meeting showed how the reduction in opioid prescriptions cannot solely be the solution to the epidemic, as the delicate balancing act has been disrupted. “Anyone listening today heard a clear and resounding message from patients who…will undoubtedly pay a cruel price in days of increased pain,” said Cindy Steinberg, US Pain Foundation, according to the National Pain Report. “Their message was clear – we are sick with devastating pain conditions yet doctors will no longer treat us. We have been forced off opioid medications we have used appropriately that have helped us to function. We are suffering to the point that many of us are losing the will to live.”

Just as thousands of Americans are suffering from pain, thousands of Americans are suffering from addiction. While both are deadly, disrupting the balancing act may have more significant long term repercussions. As politicians debate curbing the epidemic, physicians and patients alike are clearly calling for a better solution to treat pain, as the crisis will only persist without alternative treatments. In the meantime, as hospitals discuss best prescribing practices, it’s critical to consider how to produce the best outcome for all parties.

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