Changing Attitudes About Opioid Prescriptions

April 4, 2016 | Health Care
Because of the heroin epidemic, health care professionals are looking to reduce the number of opioid prescriptions.

By Brenda Flanagan

“The last time he went in for treatment he was doing 40 bags of heroin a day,” said Patti Dorenzo.

Dorenzo’s son took the same highway to addiction hell as many other heroin addicts: via an on-ramp paved with prescription painkillers, opioid meds like OxyContin. She told his story at an NJTV forum.

“He had been abusing prescription pills and when he could no longer afford them on the streets, he turned to heroin,” she said.

CDC data shows approximately three out of four new heroin users report abusing prescription opioids prior to using heroin. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled. It started when OxyContin — made by Connecticut-based Purdue Pharma — cascaded onto the market, according to medical reporter David Armstrong.

“Purdue Pharma launched an aggressive and expensive marketing campaign to both convince the public this was a safe and effective product to use, and more importantly to get doctors to prescribe it. And one of the ways they did that was to convince doctors that the drug they were selling was not addictive. And this turned out to not be true,” Armstrong, of STAT Medical Journal, said.

“We’re trained, as health professionals, to alleviate suffering and so it created a whole generation of providers who — with the best of intentions — were thinking they were doing that by prescribing these medications. And we’re faced now with glaring evidence that in many cases the medications we were prescribing were having unintended consequence,” said Dr. Daren Anderson, vice president of the Weitzman Institute.

In 2007, Purdue Pharma — which has two facilities in New Jersey — admitted it “misbranded” OxyContin, and paid a $600 million fine. But the demon was out of the bottle. “In 2012, health care providers wrote 259 million prescriptions for opioid pain medication,” the CDC reports, “…enough for every adult in the United States to have a bottle of pills.” Seventy-eight Americans die every day from opioid overdose. The CDC just issued new guidelines noting, “Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.” Doctors need to relearn pain management.

“I was shocked to learn how little time residents in medical schools were spending time just trying to figure this stuff out,” said President Obama.

Sixty U.S. medical schools — including Rutgers NJ — will start integrating non-opioid pain management into their curricula. It means ditching the culture of feel-good pills.

“I think that doctors and pharma companies have gotten into that, but there’s a belief that it’s OK to take these medications so you can feel wonderful. Well, that’s not true. There’s a certain amount of pain that has to be tolerated as you go through the healing process,” said Dr. Robert Johnson, Sharon and Joseph L. Muscarelle Endowed Dean at Rutgers New Jersey Medical School.

Johnson also endorses stepping up oversight with an all-electronic prescription system, like New York’s. So does transplant surgeon Dorian Wilson, who also uses New Jersey’s Prescription Monitoring Program.

“What I’ve found, to my chagrin, is that often patients who’ve come to ask me for narcotics are obviously getting large sums and large quantities of narcotics from other physicians,” said Wilson, assistant professor of  surgery at Rutgers New Jersey Medical School.

But Big Pharma continues to market powerful opioids. The FDA controversially approved a pure form of hydrocodone, and OK’ed OxyContin for use in children. Purdue Pharma released an OxyContin pill that’s harder to crush and abuse, but STAT’s suing to access sealed court documents on how the company marketed its best-seller.

“We have a fundamental belief that they should be public, given the intense public health crisis we face now with the abuse of opioids,” Armstrong said.

All along, advocates have played catch up in their response to this opioid crisis. They say, to beat this epidemic, America will have to embrace a new culture to approach to pain management.

For more stories that are part of the initiative Healthy NJ: New Jersey’s Drug Addiction Crisis, click here.