How a Holistic Approach to Pain Management can Solve the Nation’s Opioid Epidemic

          In 2017 drug overdoses became the leading cause of death for Americans less than 50 years old (Reynolds, 2017). Fueling this statistic is the opioid epidemic, which is responsible for 63% of all drug overdoses in the nation and 91 deaths per day (CDC, 2017). In fact, according to the Journal of the American Medical Association, American life expectancy has dropped by two and a half months for the first time since 1993 (Dowell, 2017). Physicians and researchers have determined that this drop in average life expectancy is a direct result of the opioid crisis in the United States. The high number of fatalities due to opioid use is coupled with the alarming fact that for every fatal overdose there are 30 non-fatal overdoses (Frazier, 2017). The rising number of opioid users and overdoses puts a significant economic burden on the healthcare system, estimated at $78.5 billion annually. However, the economic burden pales in comparison to the pain and suffering that the opioid epidemic causes to victims and their families.

          A rise in opioid prescription rates has had a direct correlation with a rise in the number of fatal overdoses. Between 1999 and 2010 opioid prescription rates skyrocketed to quadruple their initial rate.

By 2014 those rates peaked, and according to experts, there were enough painkillers in circulation for every person in America to have their own bottle (CDC, 2014). The rise in prescriptions for opioids is attributed to the changing protocol in treating chronic pain. Prior to 1999, opioids were strictly prescribed to patients suffering from acute pain symptoms related to surgeries, cancer or severe tissue damage. By the turn of the 21^st century the parameters that governed opioid prescriptions expanded to include chronic pain conditions, such as back pain. However, it has been scientifically proven that treating chronic pain conditions with opioids leads to its accumulation in the blood system, increases tolerance, and fuels the dependence and need for stronger doses over time. Consequently, increases in the number of opioid prescriptions has, in turn, propelled the market for heroin as four out of every five new heroin users started out misusing prescription painkillers (Jones, 2013). Heroin is a cheaper and more dangerous alternative to prescription medication and accounts for more than half of all opioid overdoses (CDC, 2017). Thus, after looking at the evidence, one can suggest that overprescribing and poor understanding of chronic pain management have served as contributors to the opioid epidemic spiraling out of control.

          Simply prescribing opiates alone to treat pain has been one of the biggest failures of the modern, American healthcare system, which has created illicit drug users, increased medical expenses and claimed countless lives. A solution to the opioid epidemic is inextricably linked to being innovative in pain management. According to Dr. Benjamin Miller of the Well Being Trust, the solution to the opioid epidemic is integrated care, which takes a holistic approach to pain management by treating the physical and mental health needs of patients (Miller, 2017). Integrated care positively affects both those starting pain management and those who wish to transition from opioids for pain management. For those beginning pain management treatment, integrated care uses evidence-based approaches to treat the source of pain, such as mindful meditation, yoga, acupuncture and chiropractic care. Integrated care couples the aforementioned, non-opioid, evidence-based approaches to pain management with behavioral therapy that helps those dealing with pain to adjust to the lifestyle changes that chronic pain brings. This coupling of therapies steers individuals away from opioids, and thus addiction, while effectively helping them deal with chronic pain and restore their quality of life.

          The most common form of integrated care for those already using opioids is “medication-assisted treatment”, or MAT, which provides behavioral health therapies along with pharmaceutical treatment for pain management. MAT therapy uses medications such as Buprenorphine and Naloxone, opioid antagonists, and couples them with intensive behavioral therapy. The purpose of treating patients in this way is to ease the patient’s discomfort while also addressing any mental health issues—such as depression and anxiety—that make users vulnerable to addiction. This is of utmost importance because the relationship between opioid use and mental health problems are cyclical. Individuals with mental health problems are more likely to abuse opioids, while prolonged opioid abuse causes mental health issues. The only way to break the cycle of misuse is through integrated care that treats physical and mental ailments related to pain management. Because of its multi-faceted approach, MAT has been proven to be a highly effective way of treating opioid addiction, as the pharmaceuticals remove the need to use opioids while behavioral therapy solves underlying mental health issues related to addiction (NIDA, 2016). In support of MAT, the director of the National Institute for Drug Abuse, Dr. Nora Volkow said:

“Outcomes are much better when you are on medication-assisted therapy. For one, it decreases the risk of relapse — significantly. Second, MAT has also been shown to be effective in preventing infectious diseases like HIV. Third, medication-assisted therapy has been shown to be effective in preventing overdoses” (Sheridan, 2017)

          While the opioid epidemic is daunting, with the right course of action it could soon be a thing of the past. Moving forward, policy initiatives to target the opioid epidemic should be wide-ranging so as to combat the problem on multiple fronts. First, a limit on the length of opioid prescriptions should be enacted so that opioids are only used for acute pain instead of chronic pain. Putting a limit on the length of an opioid prescription, such as a week, ensures that patients and their physicians are discussing their treatment more frequently. Next, legislative incentives to insurance providers should be put in place to allow and motivate them to cover evidence-based, non-opioid pain management treatments such as acupuncture. Taking a comprehensive policy approach will combat the opioid epidemic by decreasing overdoses, fatalities, prevalence of opioid use and save billions of dollars in healthcare costs, while improving the quality and duration of American lives.

References

Center for Disease Control. (2017, August 30). Opioid Overdose. Retrieved September 18, 2017, from https://www.cdc.gov/drugoverdose/epidemic/index.html

Dowell D, Arias E, Kochanek K, Anderson R, Guy GP, Losby JL, Baldwin G. Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015. JAMA. 2017;318(11):1065–1067. doi:10.1001/jama.2017.9308

Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6):1108-1116

Frazier, W., M.D., MPH, Cochran, G., PhD, & Lo-Ciganic, W., PhD, MS, MSPharm. (2017, August 22). Medication-Assisted Treatment and Opioid Use Before and After Overdose. Retrieved September 19, 2017, from http://jamanetwork.com/journals/jama/article-abstract/2649173

Gelzer, A., M.D., M.S. (n.d.). Delivering Integrated Care for Individuals with Chronic Pain and Opioid Addiction. Address presented at Alliance For Health Policy Speaker Series in Russell Senate Building, Washington D.C.

Guy GP Jr., Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:697–704. DOI: http://dx.doi.org/10.15585/mmwr.mm6626a4.

Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi: 10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12

Miller, B. F., PsyD. (2017, September 15). Pain: Integrating care for whole person solutions. Address presented at Alliance For Health Policy Speaker Series in Russell Senate Building, Washington D.C.

Morris, W., M.D., MPH. (n.d.). Opioid Assessment Service: Palo Alto Medical Foundation. Address presented at Alliance For Health Policy Speaker Series in Russell Senate Building, Washington D.C.

NIDA. (2016, November 1). Effective Treatments for Opioid Addiction. Retrieved from https://www.drugabuse.gov/effective-treatments-opioid-addiction-0 on 2017, September 19

Reynolds, D. (2017, June 06). Overdoses now leading cause of death of Americans under 50. Retrieved September 19, 2017, from https://www.cbsnews.com/news/overdoses-are-leading-cause-of-death-americans-under-50/