"Crisis" is fast becoming an inadequate term to describe the human toll of opioid addiction and overdose in the United States. In fact, more people died in the U.S. from drug overdoses in 2014 than any previous year on record, according to a recent report from the Centers for Disease Control and Prevention. Out of those deaths, 61 percent involved some type of opioid.
With these statistics--and the exponential increase in opioid prescriptions over the past 20 years--in mind, WebMD and Medscape recently surveyed their respective audiences to gain their perspectives on the problem.
For further insight into the results, FiercePracticeManagement spoke with Michael W. Smith, M.D., medical director and chief medical editor at WebMD.
FiercePracticeManagement: Which of the findings, among consumers and physicians, did you find the most surprising?
Michael Smith: What was of most interest to me on the physician side was that physicians are extremely concerned about this problem. Pretty much unanimously—99 percent—were concerned about the issues around opioid prescribing and addiction, so much that it has driven down prescribing of opioids in recent years. Sixty-nine percent said they've written fewer prescriptions for opioids in recent years.
On the other side, 35 percent of consumers tell us they have taken an opioid in the past three years. Keep in mind that this survey was sitewide and not targeted at chronic pain patients. So we know that still many opioid prescriptions are written daily despite the fact that healthcare providers are concerned that patients take more than prescribed, share pills or use them for reasons other than what they're prescribed for. So it's surprising that even though it's a great concern among providers that patients will get addicted, and use is decreasing, opioids are still an extremely common go-to treatment for pain.
FPM: How does the time pressure on many physicians play into the problem?
Smith: Keep in mind that for the most part, these opioids are being prescribed by primary care providers, the busiest doctors no doubt. These providers are on the front lines and expected to quickly address and resolve issues, with patients turning to them to help them not miss work. So what's the easiest, most effective option? Opioids. That's not what we should be doing, but doctors are under such pressure to deal with these issues quickly and effectively that it's what doctors are often doing.
Interestingly, from the survey of healthcare providers, they told us they felt the biggest solution would be prescription monitoring programs. The problem is that those already exist; doctors just don't use them because it takes even more time out of a busy doctor's day to dig into those tools and find the information they need.
FPM: So what do healthcare providers need to be more empowered to address this problem?
Smith: What we need is more education. The problem starts during training. I can tell you from personal experience that you get almost no training on the appropriate use of opioid painkillers in medical school or residency. What doctors need absolutely is education around when to use them, when to prescribe them and, honestly, probably most importantly, how to talk to patients and have them be happy with alternatives.
Therefore, we need to educate primary care physicians on both the appropriate use of opioids and the use of a multipronged approach for the treatment of pain, which might include physical therapy or other modalities. The problem is that requires more time and more pressure on the physicians to educate the patients. But we need to educate the healthcare providers so they understand how to educate the patient.
Editor's note: This interview has been edited for length and clarity.