Perspectives on the Opioid Crisis

The United States population makes up approximately 5% of the entire world’s population, yet we consume 80% of the entire world’s opioid prescription drugs. In 2017, 130 people died each day due to overdoses related to opioid prescriptions, up from 11% in 2016.

The opioid crisis is not new but continues to grow more prevalent in the news and has begun to touch every walk of life. At PBMI’s 2019 National Conference, a panel focused on prescription opioid vigilance comprised a patient, prescriber, pharmacist, and attorney who all discussed how opioid dependence has effected their personal and professional lives.

Panelists included former attorney for the United State Department of Justice and the Drug Enforcement Administration (DEA), Jonathan P Novak, Esq, Robert Riley II, cofounder of the Missouri Network for Opiate Reform and Recovery, cofounder of Rebel Recovery Florida and the Missouri SAFE Project, and addict in recovery, Christine Hopkins, MSN, FNP-BC, APN, nurse practitioner, Betty Ford Center, and moderator, Sonja Quale, PharmD, chief clinical officer & vice president informatics, Confidio. 

Former DEA attorney, Mr Novak, described his time with the DEA tracking down opioid prescribers, providers, as “taking down drug dealers in lab coats.”

“Humans have known that opioids were bad from the beginning. More information keeps coming out but from their initial introduction to the market, we knew that they were addictive and had the potential to be abused,” said Mr Novak who referenced a letter a doctor wrote to the New England Journal of Medicine in 1980. “The letter—not a study, which is important—stated that opioids were only addictive 1% of the time, that at the end of their treatment, only 1% of their patients were still using opioids. This was because the rest of the patients had died.”

Mr Novak said there was never a better day for him than when they would shut down corrupt practices that had caused patients to become addicted and eventually die. The opportunity to help a community that was suffering was one of his main drivers in working with the DEA.

A subject already sensitive to consumers often puts prescribers and providers in a difficult place. The guidelines for opioid prescriptions are complicated, varied, and call for a level-headed sense of judgement. Nurse practitioners and prescription providers, like Ms Hopkins know that their critical judgement could literally make a life’s difference when it comes to addiction. 

“We need to assess a patient’s pain level and decide what to provide. However, patients who are already chemically dependent will not have the same pain threshold as individuals without and we are supposed to do everything we can to handle their pain.” Ms Hopkins continued, “A lot opioid addictions begin with a primary care physician prescription. So with the Betty Ford Center, we do a lot to provide education and help all involved understand the potential ramifications of using opioid pain medication. 

Mr Riley, holds a unique perspective on the severity opioid addiction can have on one’s life, having been a user himself from 1984 to 2006. 

As a surviving addict, “One of our favorite sayings is ‘Nothing about us, without us’ so I always appreciate the opportunity to speak on my experience and offer what insight I can. It is important to have us at the table if you want change to happen.”

Treatment for opioid-use disorder is so varied and vast that regulation hardly exists. Mr Riley stressed that the industry continues to use its moral compass to legislate opioid addition recovery when it needs to pay attention to facts. “Even though data supports it, 70% of treatment facilities do not offer the medication needed to help opioid-use-disorder.”

Ms Hopkins added, “Addiction needs to be looked at as a chronic disease or medical condition so that it has a regulated treatment for those affected. Just like a diabetic needs insulin to manage their chronic disease, the chemically dependent need to face their addiction every day to be able to manage it.”

Mr Riley stressed that the experience of addiction and withdrawal are nearly impossible to understand unless you have gone through it, but provided a metaphor to make others understand.

“Imagine I locked us all in this room and dropped the temperature below zero. You would begin to feel colder and colder. This is how withdrawal starts. When an addict is cut off cold-turkey, much like if we were all trapped in this room getting colder, worry begins to set in,” Mr Riley continued. 

“You begin to huddle together in the room, to find some sort of warmth or a sense of relief but I just drop the temperature again so now you’re starting to panic—you start thinking you could die if you can’t get warm,” said Mr Riley. “That’s when I drop blankets from the ceiling. Now, before you go and grab a blanket, you have to know that these blankets are riddled with the world’s most egregious diseases and while the blanket will bring you warmth, it could likely kill you. What would you do?” Mr Riley painted a picture of an addict battling relapse, knowing full well that going back to the drugs could kill them but recognizing that withdrawal feels like and could very well end up in death anyway. 

“The history of prohibition in our country shows us that cutting off access only creates the drive for procuring the supply elsewhere, often in a dangerous manner,” said Mr Riley. Creating more regulation for healing those in recovery and understanding the disease of addiction is crucial to fixing the opioid crisis.  

“Yesterday morning I woke up and a good friend of mine passed away from an accidental overdose. The fight continues,” said Mr Riley. We’re losing a whole generation and we’re losing the fight. One in three people in this room have been affected by an opioid death and we need to do something about it.”— Edan Stanley