Addiction has been a problem for many years, but it has now reached epidemic proportions across the U.S., with more than 28,000 deaths in 2014. In Massachusetts alone, nearly 3,800 have died in the last five years.
The nature of today’s opioid addiction, however, is quite different from that of previous years, and the growing epidemic has captured the attention of national and state officials, law enforcement officers, the public health and medical communities, and citizens of all ages.
The April edition of Physician Focus provides some perspective on the opioid epidemic, discussing the origins of the problem; the roles of prescribers and patients; actions taken by medical, state, and public health agencies to reduce the abuse; and the provisions of a new state law created specifically to fight the epidemic.
The program features two physicians who have been at the forefront of addressing the crisis: Monica Bharel, M.D., M.P.H., Commissioner of the Department of Public Health for the Commonwealth, and Dennis M. Dimitri, M.D., 2015-2016 President of the Massachusetts Medical Society, the statewide professional association of physicians.
“What’s different about this current crisis,” says Dr. Bharel, “is that when you ask individuals about how they came to their current addiction, so many of them talk about starting with a prescription from the doctor’s office.”
Another difference lies in those who are affected. “We’re really talking about the entire spectrum of the population of the Commonwealth,” says Dr. Dimitri. “It doesn’t matter whether you’re rich or poor, or live in the inner city or out in the rural areas….This is a problem that has permeated across all parts of our society, and all of us have the potential to be vulnerable.”
Still another critical difference is how the view of addiction has changed. It is now regarded not as a criminal activity, but rather as a disease, similar to other chronic diseases, and that is changing perspectives on treatment.
Dr. Bharel noted that the opioid epidemic is the state’s “top public health priority, as the burden of substance use disorder is rising rapidly.” A major effort began in 2015 with Governor Baker’s Opioid Working Group, whose report listed 65 recommendations to fight the epidemic concentrating in the areas of prevention, intervention, treatment, and recovery.
Physicians, says Dr. Dimitri, have recognized the problem of overprescribing as well, and have taken a number of different approaches to curb the abuse. One of the very first steps, he said, was to raise the consciousness of prescribers.
“Just as we need to raise the consciousness of the public about the seriousness of the opioid epidemic,” Dr. Dimitri said, “our physicians need to better understand it as well, so they can learn better how to be safe about their prescribing and how to identify patients who may be at risk for addiction and misuse.”
Among physician efforts noted by Dr. Dimitri have been the issuance of new prescribing guidelines, free courses on pain management and opioids for prescribers, public service campaigns on safe storage and disposal of medicines, and new curricula in opioid prescribing for students at the state’s four medical schools.
Both physicians agree that one of the key issues in this crisis is the ability to manage patients’ pain and at the same time balance that goal with the potential for opioid misuse.
And they both agree that solutions to this epidemic must come from both the public and private sectors and all segments of the state: elected officials and individual citizens, law enforcement and addiction specialists, prescribers and patients, as well as community groups across the Commonwealth.
“Medicine alone will not solve this problem,” says Dr. Bharel. “We need education, law enforcement, parent groups, and community members to all come together and attack it with every tool we have.”
Watch the above video for additional discussion, including conversation about how the epidemic became so bad, the importance of erasing the stigma of addiction, the use of naloxone in saving lives, how the Prescription Monitoring Program is helping to reduce “doctor shopping,” and how the new Massachusetts law is intended to help in the four areas of prevention, intervention, treatment, and recovery.