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Commentary: Limiting Opioid Prescriptions Alone Won’t Cut It

Pending legislation promises to offer more treatment alternatives for patients in chronic pain

Last year, approximately 72,000 Americans died from drug overdoses and around 50,000 of those deaths involved opioids. Many of those opioid overdoses involved another drug, such as alcohol or benzodiazepines. Aggressive over-prescribing and a systemic failure to educate patients and their families about the potency of prescription medication has made opioid addiction one of the most difficult medical challenges of our generation. But one crucial component often left out of this discussion is the very reason patients are seeking powerful prescription medication in the first place: Pain!

Millions of Americans live each day with severe pain caused by various acute and chronic conditions. In fact, according to a recent study by the Institute of Medicine, more than 100 million Americans suffer from chronic pain every year. Another study by the National Institutes of Health in 2015 showed that 11.2% (25 million American adults) reported having pain every day for the previous three months. Managing pain costs our country collectively over $600 billion in medical treatments and lost productivity, in addition to inducing immense emotional and physical distress for members of our most vulnerable communities, including veterans and individuals with disabilities.

While addressing the opioid epidemic means reducing the act of over-prescribing and tackling addiction, including misuse and abuse in the medical system, as well as reducing the proliferation of illegal and counterfeit opioids, it also means locating the root cause of the crisis: pain. In other words, it’s impossible to truly mitigate the opioid epidemic without also bringing the pain epidemic under control.

The healthcare community needs to support a range of treatments which include limited, controlled, physician-supervised opioid prescriptions as well as a full range of effective alternatives to opioids, including non-opioid medications coupled with complementary and interventional pain procedures, such as site-specific injections. When administered by a fellowship-trained professional, these multimodal treatments may offer life-altering pain relief and significantly decrease a patient’s long-term dependence on opioids.

For this reason, I am encouraged that the US House of Representatives recently passed two bipartisan bills to encourage non-opioid alternatives for Americans facing severe levels of acute and chronic pain. The first is the Post-Surgical Injections as an Opioid Alternative Act, led by Congressmen John Shimkus (R-IL) and Raja Krishnamoorthi (D-IL), which restores Medicare reimbursements for safe non-opioid interventional pain procedures that help Americans suffering from acute pain, typically in the neck and back. These procedures, such as epidural steroid injections and facet joint injections, require physicians to locate the source of an individual’s pain rather than masking the problem by simply prescribing opioids.

The second bill is the Postoperative Opioid Prevention Act, sponsored by Congressmen Scott Peters (D-CA) and Dr. Larry Bucshon (R-IN), which replaces an existing federal incentive to prescribe opioids with an incentive to create less-expensive, less addictive painkillers. It is imperative that the US Senate take up and pass both of these bills, and that Congress continue to consider the symbiotic relationship between excessive pain and the opioid epidemic.

Next week, I will be giving several presentations about proper pain management, including as a keynote speaker, at PAINWeek 2018 (follow PPM's coverage), the largest annual convergence of pain management professionals from around the world. There has never been a more important time to spread awareness about acute and chronic pain, to educate Americans and their families about safe and effective non-opioid medical procedures and treatments, and to encourage our government and community leaders to enact policies that reduce opioid addiction and improve pain alleviation.

The opioid epidemic is born of a crisis of addiction but also a crisis of pain and how we treat it. Limiting opioid prescriptions alone won’t cut it as long as America is a Nation in Pain.


Dr. Jay Joshi is a member of the PPM Editorial Advisory Board, and CEO and Medical Director of the National Pain Centers. The views reflected here do not necessarily represent those of the National Pain Centers.



Last updated on: August 29, 2018
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