The U.S. Surgeon General called attention to the country’s record-high rates of drug overdose deaths, many due to prescription painkiller misuse, in a report released this month.
The report, titled “Facing Addiction in America,” also addresses misuse of alcohol and other drugs.
The rise in opioid prescription drug abuse has played a key role in bringing drug and alcohol misuse to a crisis level.
Every day in the U.S., 78 people die from an opioid overdose, a number that has nearly quadrupled since 1999, according to the report.
“Above all, we can never forget that the faces of substance use disorders are real people,” wrote U.S. Surgeon General Vivek Murthy. “How we respond to this crisis is a moral test for America.”
Addressing this epidemic is not only a moral obligation, the report says, but in the country’s economic interest as well.
According to the report, more than 10 million full-time workers have a substance use disorder, and research shows that substance abuse prevention and treatment programs are a cost-effective way to improve worker productivity. (p. 7-2)
The opioid epidemic
The report lays out a number of staggering statistics related to the rise in opioid painkiller misuse:
- According to the 2015 National Survey on Drug Use and Health, 18.9 million individuals reported misusing prescription psychotherapeutic drugs in the past year. Prescription opioid pain relievers such as OxyContin and Vicodin accounted for 12.5 million people. (p. 1-8)
- The number of emergency department visits involving narcotic pain relievers increased by more than 200 percent from 2005 to 2011. (p. 1-14)
- Of the 47,055 drug overdose deaths that occurred in 2014, 61 percent were the result of opioid use (including both prescription opioids and heroin). (p. 1-14)
- Heroin overdoses were more than five times higher in 2014 than in 2004. (p. 1-14)
- In 2014 there were more overdoses from prescription drugs than illicit drugs. (p. 1-14)
- The incidence of neonatal abstinence syndrome, affecting newborns exposed to drugs while in the womb, increased five-fold from 2000 to 2012. (p. 6-11) These newborns are more likely to have low birth weight and respiratory complications.
- Opioid painkillers are the most prescribed class of medications in the U.S. with more than 289 million prescriptions written each year. (p. 1-14)
According to the report, the crisis began with over-prescribing of opioid painkillers starting in the 1990s. This led to a resurgence of heroin use “as some users transitioned to using this cheaper street cousin of expensive prescription opioids.” (p. 1-14)
One key message Murthy makes in the report is that addiction should not be viewed as a moral failing, but a medical condition deserving of investment in prevention and treatment.
“We must help everyone see that addiction is not a character flaw — it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer,” he wrote.
Efforts to combat opioid misuse
The report also highlights a number of efforts being taken to prevent opioid misuse, including:
- Prescription drug monitoring programs: These are statewide databases of information on prescription drugs that are prescribed and dispensed. According to the report, research on their effectiveness has had mixed results, but some studies show they result in decreases in prescribing controlled substances and in patients seeking out multiple prescriptions for the same drugs (aka “doctor shopping”). (p. 3-25)
- Guidelines for physicians: The Centers for Disease Control and Prevention issued recommendations to help doctors know when (and when not) to prescribe opioids for chronic pain, and how to choose the right drug and dosage. (p. 3-26)
- Overdose-reversal drug: Public health officials are working to increase the availability of a drug called naloxone that can prevent death after an overdose has occurred by blocking the effects of opioid painkillers on breathing and heart rate. (p. 4-11)
A vision for the future to combat the opioid epidemic
Although steps are being taken to prevent opioid misuse and overdose deaths, the report calls for more to be done. Following are a few of the recommendations made in the report:
- Research: The report calls for more research on how to care for people with both opioid use disorders and chronic pain to treat both conditions effectively. (p. 4-42)
- Coordination between care providers: Emergency departments and primary care providers can help prevent tragedies through better coordination, the report says. According to the report, “a recent study found that doctors continue to prescribe opioids for 91 percent of patients who suffered a non-fatal overdose,” and that 17 percent of those patients overdosed again within two years. (p. 6-4)
- Collaboration between federal government and pharmaceutical companies: The report calls for continued collaboration between the government and those who make and sell prescription drugs. This could include “examining and revising product labeling, funding continuing medical education for providers on the appropriate use of opioid medications, developing abuse-deterrent formulations of opioids, prioritizing development of non-opioid alternatives for pain relief and conducting studies to determine the appropriate dosing of opioids in children and safe prescribing practices for both children and adults.” (p. 7-13)
What it means for employers and injured workers
This increased attention to the opioid epidemic will hopefully aid in helping protect injured workers from opioid addiction and all the negative consequences that come along with it.
The workers’ compensation industry has been working for years to find ways to prevent painkiller addiction among injured workers.
SFM monitors claimants’ prescriptions and proactively works with physicians to help patients discontinue their use of the addictive drugs.
From 2015 to 2016, SFM has seen a 39 percent decrease in claimants taking more than 120 milligrams morphine equivalent dosage (MED) per day as a result of these efforts.
“Many claimants have thanked us for helping them get their lives back by freeing them of their dependency on opioid painkillers,” said SFM Director of Medical Services Ceil Jung. “We’re not just doing this for cost savings, we’re doing this because it’s the right thing to do to help people have a high quality of life.”