The Opioid Crisis and the Need for Compassion in Pain Management

Mark A. Rothstein, JD

Disclosures

Am J Public Health. 2017;107(8):1253-1254. 

In This Article

Abstract and Introduction

Introduction

The tragedy of the opioid crisis in the United States has been well documented. Between 1999 and 2014, opioid sales and opioid-related deaths increased nearly fourfold.[1] Also, between 1999 and 2015, more than 183 000 people died in the United States of overdoses related to prescription opioids.[1] In 2012, health care providers in the United States wrote 259 million prescriptions for opioid pain medication, one for every adult in the country.[2] Prescriptions for these powerful opioids were encouraged and aggressively marketed to physicians and patients by certain pharmaceutical companies, often without disclosing the highly addictive nature of their products.[3] The nation is now confronting the public health consequences of opioid abuse, but we must not forget that many patients desperately need effective pain management.

As the trail of addiction and death spread across the United States, various laws and regulations were enacted to combat opioid abuse. Most notably, prescription drug monitoring programs were established in nearly every state to track opioid prescriptions in an attempt to prevent patients from engaging in physician shopping for multiple prescriptions and to prevent physicians from writing excessive numbers of opioid prescriptions.

Other measures designed to prevent opioid abuse include state laws that place limits on the number of opioid pills that can be dispensed from a single prescription, such as a seven-day supply. Private agreements between physicians and patients, including opioid contracts, also have proliferated. Among other things, these agreements typically provide that patients seeking refills must do so during regular office hours, and patients are subject to random pill counts and drug testing to ensure that they are actually taking the medicine and not diverting it.

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