Is the Patient-Physician Trust Factor to Blame for the Opioid Epidemic?

Cases of prescription opioid misuse, abuse, and addiction are still on the rise, claiming thousands of lives each year.

Nearly 15,000 people die from prescription painkiller overdoses every year. Primary care physicians are the number-one providers of opioid prescriptions, with internists and orthopedic surgeons following close behind. Brent J. Morris, MD, and Hassan R. Mir, MD, MBA, FACS, investigated the impact that the opioid epidemic is having in the orthopedic field.

“Management of pain is an important part of patient care; however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large,” Mir said in a news release.

The US consumes 80% of the opioids in the world despite only making up 5% of the population. While effective analgesia is needed for the millions of patients who are legitimately suffering with pain, especially in patients who have chronic conditions or who have undergone surgery, physicians should be wary of overprescribing opioids.

“The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing,” Mir warned.

From 1999 to 2013, the Centers for Disease Control and Prevention (CDC) reported that deaths due to prescription drugs rose by 400% among women and 265% among men.But what is the right step to take in order to curb this growing problem?

In study results published in The Journal of the American Academy of Orthopedic Surgeons, the authors advised that a comprehensive strategy of risk assessment needs to be implemented. The process can help identify patients’ history and behavior while also monitoring their medication usage through urine tests and other tools. Screening orthopedics patients for potential addiction is challenging, to say the least; however, it is crucial that prescribers across specialties identify and implement strategies that effectively address this issue.

“Reasonable expectations should be established for pain management discussions and follow-up visits. And incorporate a protocol for a patient to be transitioned off of an opioid to acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) at a specific time point following surgery,” the statement noted.

The trust factor is the key in patient-physician relationships, yet the CDC revealed that 1 out of every 20 Americans, age 12 and over, said that they used opioids for a nonmedical reason in 2010.

Becoming addicted to opioids is not the only risk that patients face. In addition they could build up a tolerance to the prescription which could make managing the pain more difficult. Finding the balance between properly controlling pain without overprescribing or unnecessary prescribing may be easier said than done, but it needs to be addressed sooner rather than later, said the authors.