CDC Reports an Epidemic of Deaths from Prescription Drug Abuse
Prescription Pain Medication is the Leading Cause of Accidental Death
The American College of Physicians (ACP) responds with new pain management guidelines for prescription pain medications used in chronic pain. Per the ACP white paper, the Centers for Disease Control suspects that opiate overdose, especially from prescription pain medications, is currently the number two cause of accidental death and according to preliminary data, may now exceed motor vehicle accidents to take over the number one position on the list. Accordingly ACP has announced a ‘Wake Up Call’ to physicians and new chronic pain management guidelines.
Few Obtain Prescription Drugs from the Street. According to a recent (2010) survey, of the 16 million Americans using controlled substances in a ‘non-medical’ way, only 4.8% obtained them from drug dealers (strangers) or the internet, 17.3% got them as routine prescriptions from their doctors, and over 55% obtained them for free from friends and relatives. Most of the friends and relatives obtained those medications from THEIR family doctor. Clearly, there are too many narcotics being given out to allow this excess of unnecessary medication to be floating around to be given to people other than those to which they are prescribed.
The Scope of the Problem
There are roughly 116 million patients with chronic pain in the United States according to recent studies. Approximately one in five patients that sees a primary care physician has a complaint of chronic pain. To put this in perspective, the average primary care physician sees approximately 20 patients per day; of those, 4 are chronic pain patients.
If each chronic pain patient receives a prescription for 4 doses of Vicodin per day (120 doses per month) the math is straightforward. Assuming 22 working days per month, the average primary care physician writes for approximately 126,720 doses of Vicodin per year (or the equivalent in other narcotics). With approximately 30,000 primary care doctors in Michigan, this translates to a staggering 3.8 BILLION doses of narcotic pain medicine annually.
Populations at Risk
Abuse by the Young- Young adults ages 12 to 25 have a prescription drug abuse rate of 6%, with 5.1% of High School Seniors admitting to the ‘non-medical’ use of Oxycontin (and 2.1% of 8th Graders). Prescription drugs are the leading leading substances abused by young adults (other than marijuana).
Abuse by the Elderly– Persons over the age of 65 account for 13% of the population and fully a third of the total prescription drug costs. Abuse of prescription pain medications in this age group may be as high as 11% according to some sources (risk factors- female, isolated, depressed with a history of substance abuse). Age related changes in metabolism predisposed this age group to adverse effects of medications, especially opiates. Medicare estimates that nearly a quarter million elderly patients, not hospice or cancer patients, were getting the equivalent of 120mg a day of Morphine or more for at least 90 consecutive days a year.
Rural v Urban Areas- While prescription drug (in many cases poly-drug) overdose has replaced heroin and cocaine as the leading drugs in fatal overdoses in both rural and urban areas, rural areas are especially hard hit by prescription drug abuse. In rural Western Virginia, prescription drug overdoses have increased over 300% in a recent 6 year period, with 58% being poly-drug overdoses on prescription medication. Demographics of Drug Abuse in the rural areas mirrors the expected peak of 12-25 year olds, but has a disproportionately higher level of 35-45 year olds compared to other regions.
What Denali Healthcare is doing about this
Denali Healthcare Pain Management is dedicated to reducing the number of prescription drugs being dispensed and available in the community. By only giving enough to control the symptoms of our direct patient, we eliminate the ‘excess’ that can be traded or given away. We do this in several ways…
- Each patient is evaluated with ‘fresh eyes’. Just because a patient was on a particular prescription pain medication program at another office, once they come to us, we will completely re-evaluate their previous medication, current need and reasonable expectations of treatment results. We tend to be quite conservative in our approach to narcotic pain medication.
- We use combination therapy at Denali Healthcare. NSAIDS such as motrin, naprosyn, mobic and voltaren work with narcotics to increase the potency of the narcotic without increasing the side effects or sedation. This tends to reduce the amount of narcotics needed to control the pain to a reasonable level (generally about 50% of the pain level they had when they came to us). We exclusively use long acting narcotics for baseline pain control with scheduled medication. We reserve short acting narcotics (Vicodin etc) for ‘breakthrough pain’ and in very limited numbers.
- Denali Healthcare uses ALL non-surgical pain control available. We fully embrace chiropractic, massage, acupuncture, biofeedback, medical marijuana, and counseling and recognize that each in their own way work toward a common goal of pain relief.
- The Suboxone Program at Denali Healthcare is here to help those with addiction to narcotics.
5 Ways Our Patients can Help…
Patient attitude and expectations play a HUGE role in the success of any pain management program. With small changes and new habits patients can significantly reduce their need for prescription pain medications.
- Be Realistic in Your Goals- Don’t expect to be pain free, strive to be ‘functional’ with reduced pain.
- If you Don’t Need It, DON’T TAKE IT- This is especially important for breakthrough pain.
- If you start medical marijuana or another treatment, reassess your pain once it ‘kicks in’. If you can reduce your medication by half, DO SO and TELL YOUR DOCTOR.
- Don’t take medication because you ‘might’ hurt if you don’t. Only take it ‘because’ you hurt.
- Realize the less Prescription Pain Medicine you take, THE BETTER IT WORKS on a pill by pill basis.