A Physician’s Perspective on the “Opioid Problem”

By now, you’ve probably heard about America’s opioid problem. Opioids are drugs which are often prescribed for the treatment of pain – which in most cases is real pain, at least initially. And while the opioid epidemic has just recently hit headlines across the country, these drugs have been a problem for decades now.

Now first lets understand the role of pain. Pain in the human body is there to signal to the individual that something is wrongand that an area of the body needs to be protected. Opioids often help numb the pain, but the problem occurs when the drugs mask a pain for a problem that still exists. The result is that the body will start producing more pain receptors, so when a person who is taking these pain medications tries to stop the pain is greater than it would have been in the absence of the medication. This is often referred to as physical addiction. If the underlying problem is never addressed, these folks end up needing more and more of the opioid medications to reach the same level of pain relief. So in many cases it starts off with legitimate pain, but then turns into cyclical opioid abuse. Often times these patients hit a certain threshold and their physician is no longer willing to prescribe the medication. Such patients then either come off the medication, enduring a severe amount of pain for a limited period of time, or they turn to illicitly purchasing prescription medication- more often heroin, because heroin costs less. Now there have been several things that have encouraged this resulting epidemic.

The first I will discuss is the pharmaceutical industry; over the past few years they have come out with stronger, and what was initially advertised as ‘more safe’ opioid medications. Trusting these statement initially lead to doctors prescribing more of these pain medications. However, as a profession, we have since found that most of those claims were not substantiated once the drug was released on the market. This is one of the reasons why I am hesitant to trust any new medication until it has been out for several years (usually at least a decade).

The second major factor that I feel has contributed to this epidemic is government regulation. Over the past few years, government oversight in the health care field has increased, which has resulted in healthcare facilities being held accountable to certain metrics, most of which don’t actually improve healthcare, but rather give insurance companies justification for paying less for healthcare. One of the most obviously detrimental metrics is “patient satisfaction.” Sure, on the surface that sounds like a good idea, but unfortunately what a patient wants and what is best for them are often not the same thing. A patient is usually looking for immediate and significant pain relief – something that is not always possible when healing the actual cause of the pain. These “patient satisfaction” scores, understandably, are negatively impacted when a patient is still in pain after their appointment – even if it is due to a legitimate medical need of time or other intervention to heal, rather than mask the pain. In many cases this has lead to physicians write for pain medications to make sure they get a good patient satisfaction score, even if it was not in the patient’ s best interest medically.

However what many physicians don’t realize is that manual medicine (Osteopathic Manipulation) has been shown to be an equally appropriate first line treatment for many type of pain, most notably low back pain (one of the most common pain-related complaints).  Additionally, this form of medicine has been practice for over a century now – far surpassing the trial of any prescription pain medication currently on the market. When done gently, the safety profile for osteopathic manipulation is better than nearly any medication out there and definitely does not have the potential for the life destroying events that, for many, has come with the use of opioids. In the past year, several pieces of legislation have come out to start curbing the over prescribing of medications. So now, with the law and the medical board cracking down on physicians who do prescribe these medications, many physicians are turning away from opioids and, instead, are having to learn of new ways to treat pain. Ibuprofen is still  most physicians’ ‘go-to’ medication, and they may even escalate to stronger anti-inflammatory medications.