In June of this year, I underwent surgery to repair my shoulder after a bike accident. Prior to the operation, my surgeon mailed me a prescription for painkillers for use after the surgery. When I opened the letter, I saw that he had prescribed me oxycodone, a potent opioid commonly used to treat pain during recovery.
While this occurrence is quite commonplace, I was surprised that at no point during my treatment before or after the surgery did he ever have a conversation with me about the potentially harmful effects of the prescribed opioids.
In the years following the development of OxyContin, pharmaceutical companies relentlessly marketed their products to physicians as a miracle drug that would treat pain with little or no side effects. In large part driven by the movement to promote pain as the fifth vital sign, physicians bought into what the companies told them – that opioids had great potential for good and almost no potential for harm. And as a result, they prescribed them. A lot of them.
The ruse however, would only continue for so long. As prescription opioids began to be used more and more, communities and public health entities began to see the effects. At its peak, in 2012, the annual opioid prescription rate in the U.S. was 80/100 persons. At the same time, opioid-related deaths went from under 10,000 a year in 1999 to over 40,000 in 2016. While illegal drugs such as heroin and fentanyl have contributed greatly to this increase, almost 15,000 of the deaths are due to prescription drug abuse. Clearly, opioids have become a true public health crisis.
Some people view themselves as far-removed from the opioid epidemic, believing that those who are abusing prescription drugs and dying of overdoses are the typical “druggies.” But that is not the case. One of the most surprising aspects of this epidemic is the change in demographics of users compared to drug epidemics in the past. The opioid-using population of today is largely made up of white, middle- or upper-income populations(2). This fact refutes the idea that every day Americans are far removed from the crisis.
This issue is not one that is happening in dark alleys or under overpasses, it is one that is largely playing out in the homes of the housewives, teachers and businessmen.
So what can be done? Are there ways to reverse the tide of what we now call the opioid epidemic, or do we have to throw up our hands in hopelessness as we watch it take its toll? Fortunately, there are. As awareness of opioid danger has grown, public health entities have engaged several tactics to combat the epidemic with some success.
Advertising mechanisms (take the billboards in Utah for example), free naloxone programs and appropriate drug disposal education are making people aware of the dangers of opioids and educating them to how they can help.
But, at the end of the day, the crisis needs to be resolved through the same mechanisms that it came to be – and that is through the physician-patient relationship. Harkening back to my story at the beginning, physicians who prescribe opioids for pain need to take on the responsibility to educate their patients on the dangers of what they are prescribing.
Physicians cannot expect their patients to understand the gravity of the situation on their own. As public servants, physicians need to be at the forefront of combating the opioid epidemic by educating their patients and carefully following up to prevent the continuation of this public health crisis.
Zach Fender
Zach Fender, Salt Lake City, is a first-year student at the University of Utah School of Medicine.
