One of the many crises facing our nation is the opiate crisis. There are many hypotheses as to how we got here but there is no doubt that things need to change. The majority of drug overdoses are related to heroin and opiate use. More people are dying from overdoses of opiates, heroin and benzodiazepines than cocaine. In the past 20 years opiate prescriptions have tripled. The opiate overdose epidemic crosses age and racial lines.
Newer prescribing guidelines suggest not starting on opiates in the first place and if they need to be prescribed they should be given for the shortest period of time and then tapered off. Of course, there are the rare occasions where opiate use may become chronic however when more people are dying from prescription drug use than car accidents, something needs to change. In an ideal world there would be no blaming of patients or doctors. There would be more responsible use of these medications.
I have a lovely patient whom I met a few years ago when she was on chronic opiates. I wanted to find the reason why she needed the medication and initially she had the same response – fear – as so many of my patients reasonably do, thinking somehow I was going to take their needed medication away. I told her I had to intention of doing that but we should find a cause for the pain and treat that instead. She reluctantly agreed. Through some additional testing I diagnosed her with Rheumatoid arthritis. She began seeing a rheumatologist and reported feeling better than she had in years. To this day she is thankful that we got her off the opiates and treated the underlying cause of her illness.
Not all stories end this way but there should always be an attempt to trial off of these medications. If patients and doctors work together there will be an end to this epidemic. Please see the Frontline special “Chasing Heroin” for more information on this topic.
Dr. Rizvi 