So much time is spent on the astonishment of the opiate epidemic in the United States.  Where did it start?  How did it get to be so bad?  Who is the most responsible party?  Most importantly, who has the greatest likelihood of making the most timely impact in reducing the overprescribing, abuse and unnecessary deaths from opioids?  After all is said and done, there needs to be greater federal and state mandates to stop the incessant marketing and prescribing of opioids as first line analgesics for chronic pain.  It is clear that current practices and usage are directly correlated with killing the thousands of people using them as painkillers, as well as facilitating recreational use and abuse. That, too, stems from overprescribing, overabundance and greater availability to secondary markets.  Refer to the blog two weeks ago, noting predictable prescribing practices by zip code.

The statistics for opioid abuse and overdose are staggering across the country.  As physicians, there needs to be a concerted effort to enact overarching federal restrictions for the marketing of opioids. The revenue stream attached to opioids is unique to the US and until the marketing aspect is drastically changed, rapid changes in prescribing practices will not likely occur. 

In the past five days another mid-twenties male died from opioid overdose and four other overdoses were seen in the ED that I am aware of.  All of them were prescribed opioids on a chronic basis. More defined restrictions at the state level are necessary to successfully enforce physician prescribing patterns. The atypical prescribing patterns of some providers and pain centers, possibly related to greater revenue from their prescribing regimens and business models, unfairly impact the practices of many others, as well as perpetuating pill shopping behavior by those addicted to opioids.  As an added caveat, there should be insight into proactively preventing prescribing patterns from being able to shift from one controlled substance to another as part of future federal and state restrictions.

“According to the US Centers for Disease Control and Prevention, the increasing use of opioids has led to parallel increases in opioid addiction and overdose deaths.” (JAMA, March 10, 2015 Vol.313, Num. 10, p, 1059.) “It is time for the FDA to do its part by exercising its regulatory authority and responsibility to prohibit marketing of opioids for common, chronic conditions.” (JAMA, March 10, 2015 Vol.313, Num. 10, p, 1059.

The combination of a multifaceted approach from state and federal regulation should ultimately and appropriately govern prescribing practices across the country.  Physician drug monitoring programs can be used to follow trends and direct prescribing patterns that follow and remain aligned with federal restrictions.   

There is no time to delay regulatory action at all levels. 

Lukas Kolm, MD, MPH


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