Commentary — May 2016
By the AMA Task Force to Reduce Opioid Abuse
Junkie, stoner, crackhead — We've all heard the terms used to describe those who struggle with drug addiction. These terms are dismissive and disdainful; they reflect a moral judgment that is a relic of a bygone era. We need to change the national discussion. Put simply, those with substance use disorders are our patients who need treatment. May is Mental Health Month, a good time to remember this important fact and to ensure we carry the message throughout the year.
Scientific progress has helped us understand that addiction — also referred to as substance use disorder — is a chronic disease of the brain. It is a disease that can be treated successfully. No one chooses to develop this disease. Instead, a combination of genetic predisposition and environmental stimulus — analogous to other chronic diseases like diabetes and hypertension — can result in physical changes to the brain's circuitry, which lead to tolerance, cravings, and the characteristic compulsive and destructive behaviors of addiction that are such a large public health burden for our nation.
Every day, 78 Americans die as a result of prescription opioid and heroin overdose. The rate of heroin-related overdose deaths has increased dramatically; 10,574 lives were lost in 2014. The nation is seeing an increase in opioid-related pediatric exposures and poisonings. The rise in neonatal abstinence syndrome as a result of women being exposed to opioids during pregnancy is distressing.
Misuse by older adults also has become an increasing concern. The rate of opioid-related hospital admissions has increased significantly over the past two decades across all age categories. Because of higher rates of substance use disorders in the current baby boomer generation, illicit and nonmedical drug use among older adults will likely increase in the future. The bottom line is, physicians must lead the nation in changing the tide of this epidemic.
The Texas Medical Association and the American Medical Association Task Force to Reduce Opioid Abuse encourage physicians and other prescribers of controlled substances to register for and use prescription drug monitoring programs (PDMPs) as one tool to identify patients in need of counseling and treatment for a substance use disorder. The trend among policymakers has been to use PDMPs to identify "doctor shoppers." This, by itself, is important, but the real work is to understand why a patient is seeking medication from multiple prescribers or dispensers and to offer a pathway for treatment and recovery. Information from PDMPs can play a helpful role in identifying patients in need of help.
TMA and AMA want to see a larger focus on prevention, which includes intervening early with teens who initiate the use of alcohol and/or marijuana, as well as efforts to encourage safe storage and disposal of medications. Unused medications increase the risk of nonmedical use by adolescents who live in the home and can be ingested by curious young children.
Implementing campaigns to educate the public on the importance of storing opioid medications locked and out of the reach of children and properly disposing of opioid medications following the end of use can encourage these safe practices.
We must actively screen for and treat comorbid psychiatric disorders in all our patients to ensure that they continue to receive the highest level of care, as patients with psychiatric conditions may have even greater risk than the general population to misuse opioids. Furthermore, our patients would benefit from more active screening, brief intervention, and referral to treatment.
As physicians, we see the harsh reality faced by our patients with a substance use disorder. Stigmatizing patients helps no one. Our goal, as physicians, is to treat our patients and help them live as fully functional members of society. There are people in recovery at every level of government, the private sector, and throughout our towns and communities. That is because treatment works.
May 2016 Texas Medicine Contents
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