By Neil Seeley & Nathan Neufeld
September 19, 2018 at 5:00 am ET
With each passing week, our nation’s worsening opioid crisis attracts increasing attention, and for good reason. More than 90 percent of surgical patients typically receive opioids to treat their pain, meaning billions of opioids prescribed each year.
Research indicates that as many as 6 percent of these patients will become persistent opioid users. The 115 people who die every single day, and the countless additional lives that have been shattered by the effects of opioid abuse, make it clear we need to act. Only a joint effort from lawmakers, the medical community and patients can ensure that we reverse the trend of this epidemic.
How can we affect this change?
In the years we’ve spent as clinicians, we’ve seen and heard firsthand the dire need to reverse course on what has become a staggering epidemic. Our experience tells us three things: First, our entire national dialogue on the opioid epidemic must fundamentally shift from how to treat addiction to how to prevent it in the first place. Second, we need to increase awareness among clinicians and patients that effective, Food and Drug Administration-approved opioid alternatives already exist. And third, we can curb this life-ending epidemic by making a few legislative and regulatory changes.
Several FDA-approved alternatives to opioids actually do already exist, which lack the high addiction risks associated with opioids while being just as good or better at controlling pain. Estimates show that if surgery-related prescribing of opioids could be cut by as little as 10 percent, 300,000 fewer people would become persistent users. Compelling figures like these have a growing number of surgeons nationwide recognizing the need for change and turning to prescribing opioid alternatives as a way to combat the opioid crisis.
On this front, there are key legislative and policy changes we must pursue at the federal level, as soon as we can, to make a real difference.
Medicare currently limits access to opioid alternatives for patients and the physicians who treat them. Opioid drugs are often cheaper, while opioid alternatives that help a patient avoid addiction are more expensive. Current regulations that do not allow patients to access non-opioids no matter the cost are counterintuitive.
Congress should work to reform the Medicare payment system to remove these obstacles and give patients and clinicians alike access to the widest possible range of treatment options instead of promoting a reliance on opioids. Lawmakers also can work to ensure that health care practitioners are compensated for the added time and resources needed to counsel patients on low- or non-opioid pain management options.
Lastly, the FDA has not yet approved a non-opioid therapy for moderate to severe pain in children. The agency should prioritize new research and options for the pediatric population given the need for alternatives to manage pain in this vulnerable population in the safest way possible.
The opioid crisis presents a complex, multifaceted problem. As such, no single action or piecemeal proposal can be expected to solve it alone. But if we approach this challenging issue with real answers, we can achieve lasting success. In doing so, we can spare future generations the pain and needless heartbreak this epidemic has wrought.
In this era of the opioid epidemic, cancer patients should not be forgotten. We must act now before we get to a stage where we are treating the cancer only for the patient to suffer the consequences of an opioid dependence in survivorship.
Neil Seeley, MD, is the chief of the Division of Anesthesia at Cancer Treatment Centers of America and medical director of anesthesiology at CTCA Atlanta, and he did his residency at the Naval Hospital in Pensacola, Florida, and the University of California San Francisco before becoming a Navy flight surgeon and the senior medical officer at the Naval Air Station in Lemoore, California.
Nathan Neufeld, DO, is the chief of the Division of Pain Management at Cancer Treatment Centers of America, as well as medical director of Pain Services and Supportive Therapies and an interventional pain management specialist at CTCA Atlanta, and he did his residency at Johns Hopkins University School of Medicine and is certified by the American Board of Physical Medicine and Rehabilitation, Pain Medicine – American Board of Anesthesiology and the American Board of Medical Quality.
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