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Pyatt: Efforts to lower likelihood over opioid addiction

There are two main components in our national opioid crisis.

The first component is exposing individuals to opioid use — whether derived from the opium poppy or synthetically manufactured — and sustaining the use over a sufficient period to cause a dependency to develop.

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The second component is effective treatment of those dependent on opioids. Both of these are interwoven and complex. Opioid use has been around for thousands of years, and its addictive qualities have been well known. Yet surprising little progress in addressing this dependency and addiction problem has been made.

I wrote an article in January on opioids and decided to expand the effort after reviewing the study described below.

Ironically, progress on the first part, long delayed, has only begun after the increasing death rate — roughly 115 overdose deaths per day in the U.S. — of the second component, failure of treatment and resulting death by overdosing. When one looks at the problem as a whole, the significant impact of this crisis takes shape.

It is not only fatalities but the slow erosion of families, leading to a significant number of essentially wasted lives. There are literally an army of “dead men walking.” In times past, affected people existed in “opium dens” where they lived in a state of almost unresponsiveness as the addiction progressed, often with a very short life expectancy.

Recently, a government-backed panel that routinely draws up guidelines for disease (U.S. Preventive Services Task Force) prepared a plan in January, after publishing it as a draft for comment in December, for research to identify evidence-based strategies to lower the likelihood of opioid addiction.

  • Commentary

Special attention will be focused on groups believed to be particularly vulnerable, such as those with mental health problems along with pain, and those with prior histories of substance use disorders.

I have been following the opioid concern for less than a year — I retired as a health risk expert — but I think this is a tall order. Opioids (morphine, heroin and synthetics) stand as effective pain management treatment. But the complex blocking of pain and anxiety developed over some time is also the same reason some (but not necessarily all) people develop a dependence on opioids.

Dr. Eellan Sivanesan of the Johns Hopkins School of Medicine was quoted in a recent Reuters article: “We all realize that there is a problem with opioids. But people are still going to have pain. We need alternative treatments for pain. Part of that is increasing access to the variety of pain treatments that are available. It’d becoming increasingly difficult to get these alternative treatments, e.g. more costly neuropathic pain medicines, authorized by insurance providers.”

Most orthopedic specialists don’t have time to discuss pain management strategies effectively, and it is quicker for them to write a prescription. In reality effective pain management tailored to a personal situation — and after careful consideration — may be a pipe dream. But we certainly must do better.

A second major hurdle is the huge amount of money being spent on oxycondone and the incredible profits being realized by the pharmaceutical industry. This conceivably could lead to biased advertising of the opioids or publishing self-serving epidemiological studies to possibly negate the ongoing Preventive Services effort.

Just reviewing the proposed plan gives me optimism. In the past six months I did some exploratory studies on my own, and I did not uncover a lot of relevant data sources, but a lot is probably in medical data bases not open to the general public .

I have participated in similar studies while employed by the federal government, and the outline serves as a basis to organize the effort. As new and relevant information arises, it is usually included. Most Preventive Services Task Force Reports are high-quality efforts, and they also tackle problems straight on. The results are published as a draft report, there is a public comment period, the comments are digested, and a final report is prepared. I anticipate a lot of interest and comments from some physician groups and pharmaceuticals on this effort.

Finally, epidemiological studies are often subjective — it is an art as much as a science — and it will be interesting to see how data, or lack of it, as well as data and modeling uncertainty are addressed.

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