Per the Surgeon General, more people use prescription opioids than use tobacco and there are more people with substance abuse disorders than people with cancer. How in the world did we get here? Our current opioid epidemic started a decade ago at which time a medical study revealed that physicians were not adequately controlling pain in terminal patients. This resulted in a push for doctors to be more aggressive in treating chronic pain and a subsequent surge in the manufacture of short and long term opioids to meet this need. Then the federal government changed physician and hospital reimbursement for Medicare/Medicaid patients based on the patients’ satisfaction with their pain control – this gave rise to the pain as the ‘fifth vital sign’ and why you are asked about your pain level every time you are seen by a nurse or doctor.
In 2010, the Centers for Disease Control and Prevention (CDC) identified a significant increase in overdose deaths due to prescription medications. Review of the last decade of opioid sales revealed a tremendous increase in both opioid sales and a parallel increase in opioid deaths. While the U.S. represents five percent of the world’s population, it was revealed that we consume 90% of the world’s supply of opioids. It was at this point that the CDC and other medical and law enforcement institutions began to identify strategies that would both limit the prescribing of opioids and the diversion of prescription opioids on the street. Medical research at this time also revealed that opioids were not as effective as initially thought in patients with chronic pain as well identifying a much lower threshold for abuse potential and accidental death. As states like Indiana implemented aggressive opioid prescribing rules for providers, more people began to turn to heroin. Unfortunately, 21st century heroin is mixed with illegally produced synthetic fentanyl which is much more powerful and deadly. The 21st century heroin addict is not an uneducated, homeless patient but rather the same patients who were being treated for legitimate medical conditions and unintentionally became addicted to opioids and can no longer find them legally with the new prescribing rules.
Due to the large number of people affected by opioid abuse, as well as continually improving brain imaging techniques, we now have a better understanding of the impact of opioids on the brain and how new medications can improve the long-term recovery rates in patients with opioid abuse. Due to our research findings, we have moved from looking at substance abuse as primarily a psychological problem to a chronic medical issue – just like diabetes and heart failure. All complex medical issues require a combination of medicinal, behavioral, and lifestyle interventions to achieve the best outcomes – we are now applying this same model to substance abuse. But this represents a significant change.
To successfully address this issue, layman and healthcare providers need to embrace the shift in the paradigm of substance abuse from a hopeless problem that affects a few dysfunctional people to a chronic medical issue, which affects a significant number of people that can be positively treated with an interdisciplinary treatment plan that includes medicine, mental health, social services and faith. The new model for recovery is one of hope and reestablishment of a functional, satisfying life. Identification of the necessary resources can be complex for both patients and providers. We are fortunate to have a one stop shop for laypersons and providers alike for education and location of treatment resources – LookUpIndiana.org – in our community. Through this website, connection to the resources that make recovery a viable option are just a click away.