America's deadliest drug problem: Our view
Opioids kill nearly as many as guns or auto accidents.
America's deadliest drug problem grew even deadlier last year, as overdose deaths from opioids hit a record 28,647, or 78 people a day.
This epidemic is fueled as much by well-meaning doctors as it is by dope pushers. Overdoses of the most popularly prescribed legal painkillers, such as oxycodone and hydrocodone, accounted for more deaths last year than heroin, according to numbers released Friday by the Centers for Disease Control and Prevention (CDC).
Many doctors who are part of the problem have shown little inclination to solve it. Shamefully, some have balked at checking with online state registries to find out if patients are doctor-shopping for multiple prescriptions.
Finally, the CDC is taking a logical step to prevent more people from becoming addicted in the first place. The agency has proposed guidelines to change physicians' prescribing habits.
Don�t tie the hands of clinicians: Opposing view
The guidelines suggest that for acute short-term pain — which gradually resolves as tissues heal, such as after surgery or a sprain — doctors prescribe the smallest supply of drugs, for three days. For chronic long-term pain, CDC suggests physicians first look to other drugs or physical therapy. If they do prescribe opioids, they should start with the lowest possible dosage and continue opioids only if benefits outweigh risks.
Two recent studies demonstrate how much these guidelines are needed. Opioid prescriptions are dominated by general practitioners — the family doctors, internists, nurse practitioners and physician assistants that most patients see for common problems — and not by a small cadre of high volume "pill mill" prescribers once thought to be fueling this epidemic, according to a study published this month by Stanford University researchers.
Further, many general practitioners do not understand basic facts about how addictive opioids are and how patients abuse them. Nearly half of those surveyed by researchers at the Johns Hopkins Bloomberg School of Public Health believed, incorrectly, that a group of opioids made with hard shells or other abuse deterrents were less addictive than their counterparts. The pills can’t be easily crushed, for example, to be snorted, but they are every bit as addictive if taken by mouth.
Such ignorance suggests that influential guidance can’t come fast enough. Yet critics have slowed the guidelines by criticizing their content and the process used to write them. In Washington, a delay often translates into a slow death for excellent ideas that anger powerful special interests.
In this case, the guidelines would cut into the bottom lines of companies that have made billions of dollars selling opioid painkillers. While the companies have not been public critics, organizations that get money from them have led the charge, arguing that the guidelines might block access to needed medications, according to the Associated Press.
One opponent, the American Academy of Pain Management, gets about $300,000, or 10% of its revenue, from makers of opioids. Several of the companies also sit on its Corporate Council.
Give the critics one point: The CDC process needs transparency — a problem the CDC quickly solved by lengthening the public comment period on a published draft and naming some critics to a panel that will advise on the guidelines.
Opioid painkillers certainly are indispensable to some patients, such as those with terminal illnesses for whom addiction is not an issue. But these patients are not the CDC’s focus.
For many others, prescription opioids have become a gateway to addiction, to heroin (which can be cheaper and easier to obtain than many of the legal drugs) and even to death. Last year, this category of drugs rivaled guns and auto accidents as major killers of Americans. If the CDC guidelines are defeated, the winners will be the pushers of opioids, legal and illegal alike.
USA TODAY's editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.
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