Opioids are the new aspirin, and the resulting epidemic calls for all healthcare hands on deck

Of all the problems besetting the health status of the U.S. population, the raging opioid epidemic might be the most maddening. In many ways, it’s a self-inflicted wound.

A lot of people have a legitimate need for pharmacological relief from physical pain. But how did we get from “Take two aspirin and call me in the morning” to 259 million opioid prescriptions—more than enough to give every American adult his or her own supply? The answer is that greedy drug companies, harried doctors, opportunistic street operators and, yes, intemperate patients have all played a part.

And the fallout is truly staggering. Statistics compiled by the American Society of Addiction Medicine show that drug overdose is now the leading cause of accidental death in the country.  

“Opioid addiction is driving this epidemic,” ASAM points out, citing 20,000-plus overdose deaths related to prescription pain relievers and nearly 13,000 overdose deaths related to heroin in 2015.

The heroin connection is alarming—four of every five new heroin users started out misusing prescription painkillers—and largely economic. People who get hooked on prescription opioids often find heroin cheaper and easier to get. In fact, the pills that were originally dissed as “hillbilly heroin” are now coveted as rich man’s heroin. The intoxicant made from the opium poppy the old way and the pills made in a modern lab give a closely similar high, tickling the same neuroreceptors and creating the same physical dependence. And both cause suffering when abruptly withdrawn.

Meanwhile deaths get the press, but most users don’t die by overdose. They just let their lives go off the rails. The statistics don’t itemize the jobs lost or never won to begin with. The families torn apart. The communities hurt by desperate addicts committing crimes to get their next fix. Or any of the other scenarios of real-world breakdown that come with drug addiction on this mass a scale.

But enough of the despair. Here comes some hope.

As the influential Indiana University radiologist Richard Gunderman, MD, PhD, noted last spring, federal efforts to fight opioid abuse have drawn broad support from both political parties—and scores of medical schools said they would include the latest federal prescribing guidelines in their curricula.

This year the roll continues.

• In January, Anthem announced it was going national with no-preauthorization-needed treatment payments for opioid addicts.
• In February, New Jersey cracked down on opioid prescribers by limiting initial prescriptions to just five days. The Garden State also mandated that insurers pay for up to 180 of addiction treatment without pre-auth.
• Earlier this month, the Advisory Board spotlighted the exemplary success of a pilot program testing targeted, surgery-by-surgery painkiller prescribing at Dartmouth-Hitchcock Medical Center in hard-hit New Hampshire.

And as of press time, President Trump was signaling his intent to name New Jersey Gov. Chris Christie to head a federal drug commission focused on combating opioid abuse.

I don’t know that there’s anything the medical imaging community is uniquely qualified to do in the fight against the opioid epidemic. If you do, please email me so I can help spread the word.

Till then, it’s just all hands on deck. Let’s watch for signs of prescription painkiller abuse and do whatever we can for those at risk or possibly already affected within our spheres of influence. Let’s not be afraid to reach out at home, at work or within our communities and social circles.

After all, self-inflicted wounds need healing too. Sometimes more than any other kind.