To curb the ongoing tidal wave of opioid addiction and overdose deaths, state and federal governments have put in place policies that restrict doctors’ ability to prescribe opioids such as OxyContin, Vicodin, and Percocet. Although well-meaning, these policies are unleashing several unintended — yet entirely predictable — consequences.
One is an unprecedented spike in drug overdose deaths, quite rightly described as a nationwide epidemic. When opioid pills become difficult to obtain, some patients who depend on these prescription medications to get through the day relatively pain-free switch to heroin. That’s a dangerous move because heroin, like any street drug, can be mixed with or substituted by fentanyl, and even more dangerous drug. A fatal dose of fentanyl is just three milligrams, roughly the weight of a few grains of salt. Fentanyl is what killed Prince.
Another consequence is the needless stress inflicted upon patients who legitimately and responsibly rely on opioids for various medical conditions but now find it far more difficult to access them. One of us (Alex) suffers from migraines and relies on triptans — drugs designed specifically to prevent or stop migraines — to cope. When they don’t work, Vicodin offers relief. This is a common strategy for migraine sufferers.
Josh has severe asthma and sometimes needs prednisone, a steroid, to keep breathing normally. One of prednisone’s worrisome side effects is a boost in blood pressure high enough to potentially trigger a stroke or heart attack. Coughing further elevates blood pressure, which is difficult to control in the midst of an asthma attack. Codeine and other opioids do an effective job of suppressing coughing.
Both of us have been in the position of needing opioids for our respective conditions when our doctors were not available — and no other doctor or health care provider was willing to prescribe it. That has meant hours of unnecessary migraine pain and potentially dangerous coughing.
To prevent this from happening again, each of us independently squirreled away Vicodin that was prescribed following dental procedures. We know that one day we will need an opioid but have trouble obtaining it.
We’re actually the lucky ones. Our need for opioids is sporadic. Hoarding opioids isn’t possible for people with severe chronic pain who need these drugs to function on a day-to-day basis.
The Seattle Times reported the heart-wrenching story of Denny Peck. He lived with chronic pain for 26 years following a commercial fishing accident that crushed several of his vertebrae. Peck was prescribed opioids and other medications through a Seattle pain clinic. But when the clinic suddenly closed, he could not find a doctor to prescribe the medication he needed to survive. Unable to live with the pain, Peck killed himself. “No doctor would chance losing his license due to new laws, and Denny saw no help from the medical people although he tried and tried,” his family wrote in an obituary.
Peck’s case is an extreme example of what individuals with chronic pain, and those with other conditions eased by opioids, are finding — their physicians, some of whom had been responsibly and carefully providing them with opioids for years for legitimate medical reasons, are now reluctant to do so for fear of losing their licenses. This is another unintended consequence of the latest opioid-prescribing policies.
An untenable, one-size-fits-all mindset to opioid control isn’t working.
We can and must fix this. We recommend at least three changes to existing opioid-prescribing policies.
First, the CDC’s 2016 guideline for prescribing opioids for chronic pain, the culmination of several years’ worth of government meddling in the affairs of pain patients and their doctors, should be scrapped and replaced with rules that do not punish patients with legitimate needs for opioids or the doctors who are trying to help them.
Second, it must be made clear to physicians that their licenses are not in jeopardy for properly doing their jobs. Of course, doctors who have a long history of overprescribing or abusing their privilege should be punished by the Drug Enforcement Agency. But lumping together these two groups is a grievous mistake.
Third, we should create a national health database of opioid use and users that would be made available to health care providers. Though such a system must be designed with privacy at its core, it would prevent people from doctor shopping for opioids while still allowing patients to obtain the medications they need.
To fairly evaluate any policy, the benefits of implementing it must be weighed against the risks of not implementing it. In this case, we believe the harm caused by a Draconian opioid policy is far outweighing the benefits.
Josh Bloom, PhD, is director of chemical and pharmaceutical sciences and Alex Berezow, PhD, is senior fellow of biomedical science at the American Council on Science and Health.