How we can fight the opioid epidemic

From Joshua Landau, Physician Member, North Carolina Medical Society:

As a physician, I grapple daily with the opioid abuse epidemic plaguing our state and nation. I weigh my responsibility to my patients’ well-being and to the larger community.

The roots of the epidemic are many: pharmaceutical companies promoting these drugs as a safe cure-all for pain; a culture that looks to pills to cure any ill; incomplete education for doctors and patients on alternatives to and risks of prescription opioids; threatened lawsuits for “undertreating” pain. The contributing factors go on and on.

The key question is how to ensure safe use of a substance intended to relieve suffering, but with the potential for abuse and harm. As someone on the frontlines, I have the following recommendations:

▪ Robust educational campaigns for both physicians and patients to improve safe use of prescription opioids, including heightened awareness of the risks of narcotic use, and utilization of overdose reversal agents.

▪ Non-drug and alternative options for pain control such as exercise, yoga and meditation to be implemented and reimbursed as a part of comprehensive pain management plan.

▪ Leverage technology to everyone’s advantage. The Controlled Substance Reporting System (CSRS) is a statewide drug database doctors and pharmacists can use to query all narcotics a patient has received. We need all electronic medical record systems to automatically import CSRS data.

▪ Ensure that physicians monitor opioid use by arming them with information. Include registration for the drug database in the North Carolina Medical Board licensure and annual renewal process. It would be helpful to show the physician’s opiate prescription volume, and how it compares to statewide averages.

▪ Also, notify doctors if their patient is seen in an emergency room for an overdose, dies of an overdose, or is arrested for DUI or a narcotics charge. These are risk factors doctors need to know in order to safely prescribe narcotics.

As physicians, we have taken an oath to “do no harm” and are dedicated to the health of our patients. Making a positive impact on the opiate abuse epidemic will require a concerted cooperative effort between physicians, patients, pharmacists, legislators and law enforcement. Most importantly it will require that our society evolve beyond a dependency on narcotics.