First do no harm.
The Hippocratic oath is the medical community’s creed. It guides doctors to ensure that when physical and mental health is at risk, a doctor’s first concern is to not do anything to make things worse.
The onset of the opioid crisis is testing this creed. From 2013 to 2015, Utah ranked seventh in the nation for drug overdose deaths. In 2015 that meant 24 people overdosing each month. It is a crisis – a man-made one. A medical one. A Big Pharma one.
The Drug Enforcement Agency, in partnership with state agencies and community organizations, announced on Wednesday it would be focusing efforts on a new program – DEA 360. The program takes a three-pronged approach to combat opioid abuse: aggressive law enforcement, education and reduced reliance on opioid prescription as a solution to reduce pain.
Increased law enforcement is necessary, but will be least effective in actually stopping the problem. Dealers are like skinks that shed their tail when caught, run away and grow it right back. As the DEA admitted on Wednesday, they can’t arrest their way out of this problem.
And the most culpable – pharmaceutical companies – aren’t vulnerable to law enforcement.
The Department of Health and Human Services announced in September it would award up to $175,000 to 11 health centers across Utah to increase access to substance abuse and mental health treatment. As DEA 360 targets dealers, treatment centers will have more cash to actually treat those affected by addiction and pain.
An educational campaign could make a difference. But when someone is injured and suffering in an emergency room, the billboard they saw on I-15 won’t help. Few patients have the wherewithal to stop and ask a doctor whether a prescription for pain relief is the least addictive option.
Partnership with the medical community is key. To stop the problem at its source, doctors need to prescribe fewer opioids, and follow patients who use them for pain relief closer. Licensing boards need to set stronger standards, and follow up with repetitive messaging, stricter prescription guidelines and penalties with bite.
Intermountain Healthcare announced in August it will reduce the number of pills its providers prescribe for pain – 40 percent less by the end of 2018. It is a concerted and directed effort to stopgap critical mismanagement.
The answer isn’t to merely leave patients in pain. Providers need to find alternate ways to reduce pain.
A recent study concluded that for many patients, over-the-counter medications like Tylenol and Motrin worked as well as opioids for treating severe, acute pain in emergency rooms.
We shouldn’t be just learning this now.