NewburyportNews.com, Newburyport, MA

Opinion

April 24, 2014

Opiate abuse: the physician's perspective

Across Massachusetts, lives are being wasted. State police have recorded nearly 200 deaths from drug overdoses since November, but the actual number could be even higher, as figures from the largest three cities — Boston, Worcester and Springfield — are not included in the totals.

The commonwealth is not alone. The Centers for Disease Control states that death from drug overdose is now the leading cause of injury-related death in the U.S. While drugs like heroin remain a prime cause of such deaths, CDC’s most recent figures show that most — 60 percent — of the more than 38,000 annual drug overdose deaths in the U.S. are related to pharmaceuticals. And of those, 75 percent involved opioids or prescription painkillers.

Thus Governor Patrick’s declaration last month of a public health emergency regarding heroin and opioid addiction was appropriate and welcome. (However, a judge knocked down the ban last week.) Physicians share the governor’s concern and support his goal of reducing opiate abuse.

His directive that first responders carry Naloxone is something we have long supported. The $20 million commitment for treatment is a good initial response to increase help for addicts. His focus on youth is desirable, with teen prescription drug abuse jumping 33 percent since 2008, according to the Partnership at Drugfree.org.

His desire to ban a new form of hydrocodone should be the subject of legitimate discussion about its use and potential impact in clinical practice and its addiction potential. A balance must be achieved so that patients can truly benefit from its ability to control chronic pain. Opioids are important therapies to treat acute pain after trauma or surgery, as well as to manage chronic pain, including end-of-life care.

Those who follow the drug abuse issue point to physicians as part of the problem. We write too many prescriptions, they say, and are too quick to fulfill patient requests for painkillers. Balancing pain management and potential overprescribing is an area of constant physician concern. The treatment of pain is complex and individualized for each patient, and the addictive potential of any medicine that could be harmful gives any caring physician pause. And while some physicians have been found to prescribe painkillers for financial gain, these outliers represent a tiny portion of the physician population and should rightfully pay the consequences for violating ethical and clinical standards.

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