Opioid epidemic demands bold action

Oxycontin bottle on pharmacy shelf. (Dreamstime/TNS)
Oxycontin bottle on pharmacy shelf. (Dreamstime/TNS)

Opioid addiction is the scourge of the nation and Iowa.

Because of the opioid crisis, life expectancy in this country is reduced for the second year in a row. Nationwide, according to the Centers for Disease Control and Prevention, from 1999 to 2016, more than 200,000 people died from prescription opioid-related overdoses.

Here in Iowa, according to the CDC, there are 64 prescriptions for opioids written per 100 people.

Last year alone in our state, prescription opioid sales totaled about 270 million pills, or nearly 90 pills for every Iowan. Opioid prescriptions have skyrocketed, even though the amount of pain has not materially changed. This plight shouldn’t have happened. But we can all work together to change it.

Between 1996 and 2002, Purdue Pharma, which developed the powerful drug OxyContin, changed the medical standard, or culture, regarding the prescribing of opioids. What was once a painkiller of last resort with a great fear of addiction became simply a painkilling option without the same level of addiction concerns. Today, of those prescribed opioids for acute pain, 1 in 15 will have serious use problems. It’s important to consider that four of five heroin addicts began with misusing prescription opioids.

We can help address this opioid crisis by adjusting how the medical community utilizes opioids for acute (short-term) pain, chronic (long-term) pain, and we must more fully understand and implement appropriate treatment options.

For acute pain, caused typically by surgery or dental work, we should limit initial opioid prescriptions to seven days, and in some cases only two or three days.

For treating chronic pain, finding solutions is less clear. The CDC suggests that opioids may not be more successful in attacking pain than other pain medications and techniques. (Of course, wherever alternatives to opioids are as successful or nearly successful, the medical community should use them.) Certainly the basic principles apply in long-term use for chronic pain — opioids should be the choice of last resort to treat pain and prescribed with great respect and fear for addiction. Increasing one’s dosage is a danger signal and should be regarded with extreme caution. Medical and public health experts need to continue to work together to conduct more research and give serious thought on how the medical community prescribes opioids for chronic pain needs.

Too many people are getting addicted to opioids, and the addiction is very strong and extremely hard to overcome. This makes treatment both important and challenging. There are two basic approaches or types of treatment — treatment that leads to cessation, and medication-assisted treatment, or MAT.

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MAT consists of providing a patient with Methadone, Buprenorphine or Naltrexone on an ongoing basis. These drugs are opioids but generally satisfy withdrawals without providing the euphoric high. People can live ordinary, productive lives with this kind of treatment. The medical community, government and the public must accept MAT as an important option. As to what treatment option is most effective — cessation or MAT — the preferred option is what works best for the particular individual.

We thank those Iowa medical professionals who provide treatment. There are numerous opioid treatment programs in the state, some of which offer financial assistance. The Iowa Department of Public Health has information on its website regarding a variety of treatment options and locations: idph.iowa.gov.

We can change this opioid epidemic. It will take all of us, and will take bold action.

• Tom Miller is the attorney general of Iowa.

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