Boston, MA — Overdose deaths claimed more than 64,000 lives in 2016 in the United States. That’s more than the number of HIV and AIDS-related deaths in 1995 at the peak of the epidemic.
While many players have had a hand in the U.S. opioid crisis, two leaders in the medical and public health community believe that health-care professionals are poised to drive multi-sector solutions that turn the tide of this epidemic and save lives.
On March 29, Drs. Vivek Murthy and Atul Gawande spoke about the opioid epidemic during Quality Rounds at Brigham and Women’s Hospital. Their talk, “Scaling Prevention and Treatment of Opioid Addiction,” was also a homecoming of sorts for Murthy, a former Brigham physician who was named the 19th surgeon general of the United States in 2014.
According to Murthy, the path to the opioid crisis was one of “good intentions” plagued by mistakes from all sectors. Pharmaceutical companies aggressively marketed opioid drugs, like OxyContin and Percocet, underplaying their addictive potential. Clinicians, armed with misinformation, overprescribed the drugs to their patients. Even when more data became available that should have raised the alarm, Gawande said, this information did not reach the people holding the prescription pads.
“I was fueling part of this crisis,” Gawande reflected. “We all were, along the way.”
Then, instead of investing in treatment, we tried to “jail and incarcerate ourselves out of a crisis…at tremendous costs. Not just for taxpayers but more importantly, to human beings,” Murthy said. “We have stolen the lives of so many people and their families because of the tendency we had to focus on the criminal justice approach, particularly in communities of color and poor communities.”
A solution to the crisis in the U.S. requires all sectors – health-care, pharmaceutical, public policy and law enforcement – to work together and contribute to change. For example, Murthy noted that pharmaceutical companies need to provide more funding for treatment.
And to be sure, this is an American problem. A Lancet Commission report released in 2017 highlighted that the U.S. is the only country in the world facing this crisis, while in tragic irony, millions in low- and middle-income countries suffer and die each year without appropriate access to pain relief.
Despite this grim reality, Murthy and Gawande offered hope and a call to action for the health-care community.
Murthy offered ideas about how health-care professionals can change their prescribing practices as part of prevention efforts: don’t prescribe opioids for chronic pain, consider alternatives to opioids for acute pain and limit opioid prescriptions to three-day doses.
Murthy and Gawande also encouraged health-care professionals to talk to their patients about opioid addiction. Informed patients can be the tipping point in changing harmful medical practices, like prescribing an antibiotic for every kid with an ear infection, which was contributing to the drugs becoming less and less effective.
Gawande noted that providers should talk with their patients about how to properly dispose of unused medication to keep them out of the hands of people who shouldn’t take them.
For those already struggling with opioid addiction, health-care providers can play a critical role in treatment. Medication-assisted treatment uses behavioral counseling coupled with medications to ease the withdrawal symptoms and cravings when quitting opioids, according to the Substance Abuse and Mental Health Services Administration website. Buprenorphine, naltrexone and methadone are highly effective medications, Gawande noted.
“We already know people who have chronically been on opioids for three months are thirty times more likely to die in the next five years than those who are not on opioids,” Gawande said. “The data on opioid substitution is that they produce an 80 percent decrease in drug overdose death, period. Imagine it’s 1995, at the peak of the HIV/AIDS epidemic, and we have a cure that works in 80-plus percent of people and we’re debating whether we want to give it to people.”
Access to this life-saving treatment remains poor, Murthy explained, in part because there aren’t enough facilities that offer it. He proposed that treatment should be integrated into different health-care settings, particularly at the primary care level. “We need a ‘no-wrong-door’ policy,” he said.
Gawande added, “It’s very clear that we have been very reluctant even as a profession to demand that this is part of our skill set. It’s a disease we all see. And we have to not think it’s something some other provider provides. We all have to learn how to provide it and to make it available.”
–By Margaret Ben-Or