Opioid abuse today is devastating families and destroying communities. Yet patients often need opioids to control unrelenting pain. The effort to control opioid abuse must be tempered with the need to treat pain humanely and adequately.
In 2016, opioid overdoses killed more than 42,000 people in the United States. According to the Centers for Disease Control and Prevention, deaths from prescribed opioids have leveled off since 2010, but there have been sharp increases in deaths from heroin and illegal synthetic opioids including fentanyl. Legally prescribed opioids often are the gateway to the use of heroin and other potentially lethal opioids.
Assemblymember Evan Low, D-San Jose, is doing his part to provide solutions to the opioid epidemic. Low’s legislation centers around thoughtful ways to strengthen the Controlled Substance Utilization Review and Evaluation System (CURES), a computerized database maintained by the state Department of Justice for electronic monitoring of the prescribing and dispensing of controlled substances including opioids. This database allows physicians to check if a patient is obtaining multiple opioid prescriptions by “doctor-shopping” among different offices or emergency departments.
The California Society of Anesthesiologists (CSA) applauds Low’s efforts and other state legislators who are tackling the opioid epidemic.
Physicians who specialize in anesthesiology and pain medicine are developing best practices that are reducing the use of opioids in the operating room and at the patient’s bedside after surgery. We can offer techniques like nerve blocks and epidurals that can reduce the need for opioids after painful procedures and recommend non-opioid medications to help with pain relief. When patients use fewer opioids in the hospital, they are less likely to need them at home afterward.
Physician anesthesiologists also support improved ways of helping patients who are already in the grip of opioid dependence or addiction. Harsh limits on opioid prescription run the risk of pushing people into obtaining opioids via the black market. Instead, our society needs to put financial and health insurance support behind behavioral therapy, physical therapy, mental health treatment, and advanced pain medicine techniques to help patients taper off opioid medications. For example, a medication called buprenorphine can be part of a comprehensive treatment plan to reduce opioid dependency and diminish withdrawal symptoms, but many insurance plans currently refuse to cover it.
Opioids can play an important role after surgery or trauma, and in cancer treatment, so it is critical for medical doctors to use their training and expertise to determine the best balance of opioids and non-opioid approaches for every patient. Artificial prescription limits should not be part of any policy proposals.
If misguided legislation makes it too difficult to prescribe opioids appropriately, patients will be the ones to suffer.
Low’s bill, AB 1752, would improve the CURES database by adding Schedule V controlled substances that contain opioids (such as some cough suppressant syrups) to the list of medications that are tracked in the database. We also support efforts to allow California physicians, other prescribers, pharmacists, and law enforcement to share prescription information across state lines. This change would allow review of a patient’s full history of controlled substance use, including opioid prescriptions filled beyond California’s borders.
We strongly believe that CURES can be a helpful tool in identifying and tracking controlled substance misuse, including opioid abuse. But the database must be reliable, protect patient privacy, and be technically capable of handling the large number of users and data requests. The system must be fully funded and maintained so that all authorized users can access the database easily and quickly whenever a patient needs a controlled substance prescription or refill.
A critical part in combating the opioid crisis involves educating patients and caregivers that some pain or discomfort is to be expected during the healing process after surgery, and does not need to be “fixed” or eliminated with highly addictive painkillers. Education about the risks for misuse and abuse of opioid analgesics is especially important for patients with chronic, long-term painful conditions.
Opioid prescriptions to control pain after medical and dental procedures are a large source of available opioids in our households, where they can be misused, stolen, or experimented with by curious teenagers. In our communities, we need easy, convenient drug take-back programs so that any leftover or expired opioids can be disposed of properly.
In order to curb this devastating opioid epidemic, there must be a multi-pronged approach, beginning with robust patient and public education about substance abuse and prevention. We are hopeful that efforts at the state level, such as the legislation authored by Assemblyman Low, will help physicians ensure that patients who truly need opioids are able to obtain them, while identifying the few physicians who persistently overprescribe and the patients who are doctor-shopping or otherwise misusing these powerful drugs. These policies must be based on evidence-based guidelines for opioid prescribing, non-opioid alternatives, compassionate pain medicine, and humane treatment of dependence and addiction.
Dr. Karen Sibert is past president of the California Society of Anesthesiologists.
Opinion: Evan Low’s legislation will help reduce opioid abuse