Facts from an NP on the Opioid Crisis
by Brett B. Snodgrass FNP-C, CPE, FACPP, FAANP
It only takes minutes, turn on your TV or radio and you will hear we are in the midst of an opioid crisis. It seems every professional healthcare groups in America are weighing in. Guidelines, recommendations, ideas and sometimes sensationalism is flooding the arena of healthcare. Everyone feels they have an answer to the opioid crisis.
What is always important to ask is… Is the information being reported correct? Are you really seeing the entire picture of the crisis? I really don’t think we are. The media reports that opioid overdoses have overzealous, greedy pharmaceutical companies, and overprescribing healthcare providers to blame.
Hold on.
It’s just not that easy.
Here is what we know-The current statistics about drug deaths say:
o All drug deaths (including ANY drug/medication a patient takes) account for 60,000 to 70,000 annual deaths.
o All opioid deaths (including heroin/fentanyl and prescription opioids) account for 30,000 to 40,000
Now, let’s compare to:
o Hospital-acquired infections deaths: 99,000 annually
o Tobacco, Alcohol, Guns and Traffic Accidents: >700,000 annually
It’s just important to put things into perspective.
Now let’s look at the opioid death statistics.
The number of actual prescription opioid overdose deaths are only a small percentage of the overall opioid overdose statistics.
o For instance, Fentanyl is responsible for 79% of all opioid overdose deaths. So, your first reaction might be “no one should ever prescribe fentanyl.”
o YET, only 5% of all fentanyl overdose deaths are due to pharmaceutical grade fentanyl.
For instance, in Illinois, opioid overdoses increased from 589 in 2015 to 1233 in 2016, despite significant decrease in opioid prescribing in that state. The increase appears to be almost completely driven by illicit fentanyl analogs, not legitimate fentanyl prescribed for the chronic pain patient. Schatman, Zieglar (2017) Pain Management, Prescription Opioid Mortality and the CDC.
To quote Dr Stefan Friedrichsdorf, “We do not have an “prescription opioid crisis” but really we have a polypharmacy crisis.” He cited that in New Hampshire, 72% of deaths involving oxycodone, also included alcohol, and/or benzodiazepines, cocaine, kratom, methamphetamine, and other opioids (which may not have been prescribed concurrently).
One accidental death from a prescribed opioid, illicit opioid or any other medication is one too many. But the answers are not simple. The present problem is more about illicit drugs than prescription drugs, as well as, combinations of both prescription and illicit drugs. Multiple sedating prescribed medications is also an issue. To add, more deaths are associated with illicit use of prescription opioids, than the intended prescribed reason. So many in our society, are looking for an escape and dangerously finding it through polypharmacy.
We have an epidemic of substance use disorder.
Substance Use Disorder.
THIS is what’s being ignored. That’s because there are so many factors associated: unemployment, poor education, depression, limited mental health access, mental health stigmas, availability of illicit drugs, diverted prescription opioids, genetic predisposition to substance use disorder, and psychiatric co-morbities.
Where do we go from here? More providers need to be screening for Substance Use Disorder. States need to allow more NPs and PAs to have the ability to treat Substance Use Disorder. There needs to be more education on how and when to prescribe opioids. Also, an increase in national education on appropriate disposal of medications when they are no longer needed. This act alone will help reduce the likelihood of diversion. It’s just the beginning, but it’s a start!
Reference:
Schatman, Zieglar (2017) Pain Management, Presctiption Opioid Mortality and the CDC.
Brett B. Snodgrass FNP-C, CPE, FACPP, FAANP
Director of Clinical Operations
LifeLinc Pain Center
8001 Centerview Parkway, Suite 215
Memphis, TN 38018
(P) 901-249-5905
(F) 901-249-5940