Kill Pain and Addiction
There is a grim connection between two worsening addictions in the U.S.: to prescription opioid painkillers and to heroin. Both can be partly traced to worthwhile public-health initiatives that deserve to be protected.
The first initiative was a 1990s campaign to get doctors to take people's pain more seriously. This worked amazingly well -- for some people, too well. The second effort was the recent response to the ensuing spike in opioid addiction: Legal controls on painkiller prescriptions were tightened, and some of the drugs were reformulated to make them harder to overuse.
Preventing painkiller abuse will require cracking down on doctors who may be unscrupulous, or merely careless, as well as patients. Enforcing the law is no less important than alleviating pain or reducing addiction.
A great many Americans are addicted, and lately some of them have turned to heroin as a cheap, accessible -- and illegal -- alternative. (Heroin is just another kind of opioid, after all.) Both substances are increasingly abused: painkillers by nearly 2 million Americans and heroin by more than half a million. Last year, nearly 19,000 people died from taking too many painkillers, 16 percent more than the year before, and more than 10,500 succumbed to heroin overdoses, a 28 percent rise.
Given the stubborn quality of addictions, it will take persistence to bring this problem under control.
The Centers for Disease Control and Prevention this month offered some ideas for reining in opioid prescriptions. Draft guidelines advise doctors to hold back on giving patients drugs such as Vicodin and Percocet until after they've tried physical therapy and non-opioid painkillers. If opioids are still needed, the CDC suggests they be prescribed only at low doses for a short time, and that extended-release formulations, which are easier to abuse, should be avoided. Doctors should talk with patients about their experience with the drugs and to monitor patients closely for signs of dependence, especially those who are taking higher doses. Too many doctors continue to prescribe opioids to patients who have already suffered an overdose.
All of this makes sense, and the CDC's imprimatur means the advice will be taken seriously. Yet none of these strategies can help people who are already hooked. The treatment of addiction needs to improve, too.
Wider and more consistent use of so-called medication-assisted therapies can make it easier for addicts to recover, especially when paired with talk therapy and other behavioral strategies. Better training and information needs to be made available for family practice doctors, internists, nurse practitioners and physician assistants -- the providers who prescribe the most opioid painkillers. And health insurers need to change their policies to make it easier for addicts to get more effective treatment.
Careful but effective use of painkillers is not incompatible with the treatment of addiction. Preventing and prosecuting opioid abuse need not undermine efforts to ease pain and suffering.
To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at firstname.lastname@example.org.