About half of opioid overdose deaths involve prescription drugs. With that stark fact in mind, the surgeon general, Dr. Vivek Murthy, sent an unusually direct plea last week to 2.3 million doctors and other health care workers to help fight the opioid epidemic by treating pain “safely and effectively.” A website for his “Turn the Tide” campaign highlights alternative, nonaddictive treatments for pain. Not only doctors but also policy makers, insurance companies and other players in the health care system should pay attention.
Prescriptions for opioids such as oxycodone and methadone have quadrupled since 1999, as have opioid overdose deaths — more than 28,000 in 2014, up 14 percent from the year before. While prescriptions for opioids peaked in 2012, their use remains high by historical standards. And many people who were prescribed opioids have gone on to use illegal opioids like heroin and fentanyl.
For cancer patients or people near the end of their lives, opioids are often the only effective medicine. But doctors have many more options for treating back pain, migraines and pain related to surgery — physical therapy, anti-inflammatory drugs, acupuncture, exercise and so on. Some doctors overlook these alternatives because opioids are easy to prescribe or because patients demand them.
A further problem is that some insurance plans do not cover alternative treatments like physical therapy and acupuncture, or they impose so many limits and high co-pays on them that in many cases both doctors and patients find opioids a less expensive option. In some rural areas, the nearest physical therapist may be many miles away.
One fix here seems obvious: Federal and state lawmakers can require insurers to cover these services, a cheaper option over the long term than addiction treatment. And they should also find ways to expand access to health services by subsidizing doctors, therapists and other health care workers to make periodic visits to remote areas.
Even when opioids are necessary, doctors can minimize the risk of addiction by taking a few precautions. They can write prescriptions for low doses and relatively short time periods. They should pay attention to monitoring programs that most states have set up to make sure a person is not getting multiple prescriptions from different doctors. And doctors can steer to treatment patients who are obviously addicted.
Doctors are not the only ones responsible for the opioid epidemic, but as Dr. Murthy makes clear, they’ll have to play a leading role in the fight against it.
By the NY Times Editorial Board/Aug. 30, 2016
Illustration: Na Kim, nytimes
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The Critical Role Doctors will Play in the US's Recovery from its Opioid Epidemic