I doubt there is anyone living in the U.S. who doesn’t realize we have an opioid crisis here. Politicians debate the solutions to abating the high death rate that comes along with it, however, they fail to acknowledge that there are Americans in pain. Yes, we need to be sure opioids are prescribed judiciously. However, we also need to treat patients in pain.
As a doctor, it is not always easy to distinguish a patient who has real pain from one who is just looking to score a prescription for their own addiction or for diversion. A big problem that is not acknowledged by those in DC is the fact that there are not many effective pain medications out there. Additionally, services that may help such as physical therapy, are often not covered well by health insurance companies and unaffordable for patients.
While the lawmakers haggle out drug quantity limitations and the easy availability of Narcan, we need better tools to treat pain. Much pain can be treated by fixing the root cause through modalities such as physical therapy. But, why would a patient pay more money to work hard when they can just get a pill to dull their pain? These tools must be made more accessible to patients.
Additionally, there are not many different classes of pain medications out there. Some, such as NSAIDs, can cause gastrointestinal bleeding or kidney disease. They are not meant to be taken on a long-term basis. Others such as gabapentin are not meant to treat all kinds of pain. Even over-the-counter Tylenol can cause liver problems when taken in high enough doses. We clearly need new classes of medications available to treat pain.
What can politicians do to address the crisis other than what they are doing?
1. Make insurance companies cover services such as physical therapy in a way that is affordable to most patients. Under the Affordable Care Act (ACA), preventive medical services were mandated to be made available without certain costs to the patient, such as copay. In a similar way, physical therapy services can be made available without the patient needing to pay out cash every time they go. The insurance company can foot the bill and this would indeed save costs down the road in terms of avoided spinal surgeries and joint replacements.
2. Fund pharmaceutical research towards creating new classes of pain medications that are effective and non-addicting.
3. Stiffen the penalties for those caught diverting these medications. If they are caught selling these drugs to minors, the penalty should be greater as we now have a crisis of opioids or heroin in teens.
4. Make state registries available across state lines of all 50 states. Also, it should be made available to all working in the health care profession and not just physicians. In this way, a medical assistant could be doing the search while the doctor is treating the patient.
5. Stop making mandates on physicians on how to prescribe. Yes, we all know there is a crisis and have to work to keep opioids out of the hands of those who truly don’t need it. However, when you make laws that doctors can only prescribe five days of medications at a time, you are not only making it harder on doctors but on patients as well. Imagine being a patient bedridden with metastatic breast cancer and being forced to fill your pain medications every five days. That is just cruel.
6. Stop debating. We heard all your arguments. We don’t care to fulfill your agendas. Opioid addiction exists on both sides of the aisle and while the debate rages on, more people die of overdoses.
While there is little doubt of the devastating toll opioid addiction has played in the lives of many, we still are not grasping what are the key problems. Until we truly examine why this problem exists, we will not stamp it out just be limiting the way prescriptions are written. Yes, there is some drug diversion going on and it can be a profitable business for many. But we also need to solve the problem of pain.
Linda Girgis is a family physician who blogs at Dr. Linda.
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