The opioid epidemic has hit people from all walks of life. In my duties as an acute care nurse practitioner in a busy suburban emergency department I have taken care of a lot of people who face opioid addiction, ranging from young men to elderly woman.
It is an epidemic that doesn’t discriminate. There are some people who have been hit particularly hard.
In my practice, these tend to be people with housing insecurity, job instability and who are marginalized for an array of reasons. We know that people with substance use disorder often have chronic pain or medical issues. Co-morbid trauma-related mental health issues are also very common. Efforts to reduce access to opioids has been a major component of policy and practice. This has included prescribing limits and prescription monitoring programs, with the intent that limiting access will reduce the likelihood of either initial use or ongoing substance misuse.
These are noble efforts with good intent. Prescriptions for opioids have declined over the past several years. This would seem promising, but unfortunately that isn’t the case. Despite declining numbers of prescription opioids, fatal overdose numbers have continued to increase nationwide. This is a concerning trend that illuminates the fact that the opioid epidemic is more about access.
What is the driver then, of this epidemic that is claiming thousands of lives each year, in every town, city and state in America? I think that the answer to this is pain. Pain, both physical and emotional is the driving force behind the opioid epidemic.
Much of what we have done to curb it has done little to address the underlying pain that first draws people to use, and then keeps them coming back to the substances that help provide relief from the pain. If we are going to make any inroads into stopping this epidemic, we need to first address the pain that is the root cause.
On April 1, the Petrie-Flom Center will host “Public Health Approaches to the Opioid Crisis: Overcoming Obstacles to Community-Driven Solutions.”
I will be joined by my colleagues PFC Executive Director Carmel Sachar, Jennifer Oliva, and J.J. Bartlett, President of the Fishing Partnership Support Services, to discuss a community-based approach to this epidemic.
Fishers have been hit particularly hard by the epidemic, with overdose rates five times higher than that of the general population. Oliva is an Associate Professor at the West Virginia University College of Law and School of Public Health and sees similar rates of substance use disorder and overdose in coal miners. Together, we will discuss and dissect why these populations have been disparately affected by the opioid epidemic, with an aim towards providing community-based interventions and solutions.
Any meeting on the opioid issue should start with the premise that denying access to opioids to legitimate, compliant chronic pain patients is cruel and undesirable. Some people use these medications so they can function. Taking them away in the absence of any signs of abuse will not help the issue and will be devastating for the individual. The cancer patient community and surgery patients are being negatively affected by the recent crackdown, too. Asking someone to go through cancer treatment or major surgery with no opioids or the 7 days’ worth some state laws allow in a gross over reaction. There is a difference between a minor surgery for which even less than 7 days’ worth of pain medicine is appropriate and major surgeries for which 7 days’ worth is not going to begin to address the patient’s pain so they can heal. We need to get back to letting doctors make those decisions rather than legislative bodies.