The opioid epidemic and 'do no harm'

Historically opioid medications were used cautiously by physicians for selected patients to reduce pain associated with acute injury or illness, and for those suffering from life-threatening diseases such as cancer.

This caution was based upon recognition that improper use of opioids could result in patient harm. However, in 1996, the American Pain Society, supported by opioid pharmaceutical manufacturers, promoted acknowledgment and expanded treatment of pain as the ‘fifth vital sign” by physicians in hospitals. In 2001, the Joint Commission on Accreditation of Healthcare Organizations introduced new pain standards recognizing the under-assessment and treatment of pain, which then expanded the use of opioids. In the two decades that followed opioid use and abuse has exploded, with nearly 80 percent of the world's opioid medications now being consumed in the U.S.

Between 2012 and 2017, opioid pharma manufacturers gave millions of dollars to nonprofit patient advocacy groups supporting increased patient access to opioid medications. During this same period pharma spent millions of dollars on marketing to doctors, encouraging — expanded pain treatment and opioid use for patients. This occurred despite a growing recognition that by 2015 opioid misuse and abuse was rampant.

Today, an estimated $78.4 billion dollars is being spent annually for medical treatment, lost productivity and the added health insurance and criminal justice costs of opioid abuse and dependency. Every day in the U.S. between 50 and 100 Americans die from opioid overdoses. Recent celebrity deaths illustrate the increased misuse of new powerful synthetic opioid medications, such as Fentanyl (100 times more potent than morphine). Deaths from these new opioids designed to be used only in monitored health care settings are more than doubling every year.

This uniquely American epidemic must be ended. Required will be new public policies, expanded regulation and a return to the historical values of physicians to above all “do no harm.”

All opioid prescriptions need be carefully managed by physicians and their staffs including: dosing for days not weeks, use minimum effective dosages, use of least harmful and powerful medications, use for a minimum treatment duration and prescribing the minimum total pill amount based upon expected pain to reduce unused medication risks. Use of the more powerful or extended-release opioids should primarily be limited to specific painful conditions for which opioid therapy has been demonstrated to be safe and effective or life ending conditions that are fatal, such as cancer.

Also by all health care providers prescribing opioids is expanded use of state supported controlled substance databases to increase monitoring of opioid use and abuse among their patients. Databases alone, however, cannot solve this epidemic.

Needed also will be increased oversight of the opioid pharma industry to more carefully regulate opioid marketing, distribution and consumption. A recent announcement by Purdue Pharma — maker of OxyContin — indicated that it has reduced its physician marketing sales staff by more than 50 percent. This may indicate increasing pressures on the Pharma industry from a deluge of lawsuits claiming harm to thousands of patients from misleading marketing information and inadequate addictive risk disclosure.

Strong leadership will be needed among physicians and within the medical community to change public opinions regarding treatments for pain and reduce opioid consumption to end this horrible deadly epidemic.

• Dr. William J. Robb III is orthopedic director, chief medical officer at Illinois Bone & Joint Institute.