The Prescription Pill and Heroin Epidemic: Recent Happenings
November 06, 2015 | Falmouth Enterprise
Dr. Michael Bihari
During the past several weeks, a number of newspaper headlines have expanded the dialogue about the opioid crisis state-wide and locally. These include:
- Facing Epidemic, Baker Seeks to Limit Opioid Prescriptions: 10/15 Boston Globe
- Coalition Launches Effort to Fight Opioid Addiction: 10/23 Falmouth Enterprise
- Doctors Should Work with Baker on Opioid Plan: 11/02 Boston Globe Editorial
And, in the November 2015 edition of Pediatrics (the official journal of the American Academy of Pediatrics) - Prescription Opioids in Adolescence and Future Opioid Misuse
Limiting Available Supply
According to the Massachusetts Department of Public Health, there were 1,089 unintentional opioid overdose deaths in the state in 2014 — up 20 percent over 2013. The numbers for 2015 suggest we may be headed for another increase in opioid overdose deaths.
One way to deal with this complex epidemic may be to control or restrict the supply of legal prescription painkillers as a primary prevention measure. Primary prevention is an action taken to prevent the development of a health condition in a person who is well and does not have the condition in question. For example, a 15-year old who has a wisdom tooth pulled and is given a 5-day supply of a prescription painkiller is potentially at risk of developing an opioid dependence. However, that same teen has no risk of developing an addiction problem if he is advised to take Tylenol or Advil along with using an ice pack on his jaw.
According to an editorial published in the Boston Globe earlier this week: “Governor Charlie Baker is proposing to limit practitioners to prescribing no more than a 72-hour supply for a first-time opioid prescription. Exemptions would be carved out for patients suffering chronic pain, and for palliative, hospice, and cancer care. The governor’s proposal is controversial because many doctors and dentists believe that they alone are best qualified to determine what their patients need, without such limits. Baker’s plan to limit prescription painkillers is opposed by the Massachusetts Medical Society, which views it as a misguided effort to block physicians from applying their own clinical judgment and expertise to a patient’s individual pain needs.”
Prescription Opioids in Teens and Future Opioid Misuse
Some young adults who misuse opioid medications developed their dependency following the legitimate use of a prescription painkiller to treat pain associated with an injury or surgical procedure.
According to an article published in Pediatrics this week, “individuals who have an opioid prescription by 12th grade are, on average, 33% more likely to misuse prescription opioids after high school by age 23 than those with no history of an opioid prescription.” Interestingly, “this association is concentrated among adolescents who are least expected to misuse opioids: 12th grade students who have little to no history of drug use and strong disapproval of marijuana use.”
The authors of this study note that, “This increase in the future risk of opioid misuse should be considered when determining the risks and benefits of opioid prescriptions to youth.” The study suggests that when treating pain in teenagers, healthcare providers and parents need to think about when and for how long to use prescription pain killers, especially for kids who have not had any drug-related experience. Read the entire study.
Previous Risky Business articles have highlighted how the legitimate and appropriate use of prescription painkillers may lead to an addiction problem. You can read these articles on this site:
- Opioid Pain Relievers: Protecting Our Children
- From Prescription Pill Abuse to Heroin Use
Opioid Community Coalition of Falmouth
For the past several months, a group of local leaders (convened by Falmouth Chief Edward Dunne) have been meeting to create a community coalition to respond to the ongoing epidemic of opioid addiction and the increasing number of overdoses and overdose-related deaths in Falmouth. Representatives from multiple sectors in town have met to create a core team that will help to lead a community-wide effort to get a better understanding of the opioid predicament in Falmouth and find ways to help alleviate the problem. The mission of the core team is “To save lives by mobilizing the community in order to increase awareness and reduce the availability and misuse of opioid drugs.”
Initially the coalition will focus on several key areas:
- The illegal supply of prescription pills and heroin
- The legal supply of prescription opioids
- School-based prevention and education (focusing on children, staff and parents in Falmouth schools)
- Community-based prevention and education (focusing on year-round and seasonal residents, organizations, and businesses in Falmouth)
- Community support resources including local government, town departments, research and analytics
The opioid problem is a complex issue that is troubling for communities across the country; and, it will take a great deal of time, effort, and dollars to save lives. Over time, prevention is key, but we also must address the availability of short-term and long-term treatment for people who have a substance abuse disorder as well as tackle some of the family and societal issues that contribute to addiction.