SAFE Glen Cove Coalition: Limiting Opioid Prescriptions Dilemma

According to a recent article published in The New York Times, a simulation study shows limiting prescription opioids may increase deaths in the initial years and time frames are an important factor when determining success. The study was published in the American Journal of Public Health maintaining that over a 5 to 10 year period, deaths would increase, not decrease. In the short term, many policies that would limit opioid prescriptions for the purpose of saving lives would cause people to turn to heroin or fentanyl. Other experts in the field feel that over longer periods, limiting opioid prescriptions will reduce deaths by reducing the number of people who initiate prescription opioids.

Approximately 80% of heroin users in the United States previously used prescription opioids. In some cases, they were directly prescribed narcotic pain relievers, perhaps after a painful dental procedure or operation. In addition, drugs prescribed to one person can be diverted to others who don’t use them for medical purposes. So restricting opioid prescriptions would seem to make sense. But it’s not so simple. That approach reduces access to drugs for people who legitimately need them for pain so the debate continues.

Experts have proposed more nuanced prescribing practices rather than simply cutting people off opioids. For example, prescriptions could be avoided for cases of mild-to-moderate pain such as a sprained ankle or tooth extraction. Opioids could largely be reserved for much more severe pain that accompanies major surgery and cancer, for example.

The simulation study bears this out. Reducing opioids for short-term pain saves lives in the long run, even as it leaves some patients experiencing more pain. This is the fundamental trade-off opioids present. As the pendulum swung further toward treating pain, opioid-related deaths ballooned. Now to stem the deaths, it is swinging back, challenging physicians to treat pain in other ways.

Researchers state its important to point out that the simulation may not perfectly predict the consequences of policy change. It relies on assumptions and can’t anticipate unexpected societal changes. But it does show some of the possible, unintended consequences of policies that might not otherwise have been considered.

Additionally, researchers maintain the opioid epidemic is really a syndemic, meaning it’s composed of multiple, concurrent epidemics — driven both by prescription pain medication and by illicit heroin and fentanyl. The Centers for Disease Control and Prevention estimates that more than 70,000 people died of a drug overdose in the last year, most of them from opioids. By one estimate, over the next 10 years, opioids could kill over a half million more, two-thirds from heroin and one-third from prescription pills.

Policies to address the consequences of opioids include tightening the reins on prescribing, such as policies to promote greater prescription drug monitoring or limits on how many days that opioids could be prescribed as is now expected for Medicare drug plan coverage and reflected in some private plans. Policies should also reduce harm from opioid misuse, like expanding the use of naloxone or addiction treatment.

In the short run no one policy, by itself, would put a substantial dent in the expected number of deaths from opioids. The most effective single policy, according to the study, is increasing the availability of naloxone. But doing so would reduce the total number of predicted opioid deaths over the next 10 years by only about 4 percent.

Policy interventions can prevent many deaths, as well as the other destruction that opioids bring to individuals, families and communities. But prescription opioids are neither all bad nor all good. Policies that sound sensible — potentially helping many people — could also cause a lot of damage, particularly in the short run.

To read the New York Times article, please visit https://www.nytimes.com/2019/03/04/upshot/opioid-overdose-crisis-deaths.html.

The SAFE Glen Cove Coalition is joining in the fight against this epidemic by conducting an opioid prevention awareness campaign entitled, "Keeping Glen Cove SAFE," in order to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.