To Beat The Opioid Crisis, We Need To Change How We Play The Game
The opioid crisis cost, 20 years in.
We’re more than two decades into the opioid crisis.
And despite billions of dollars in public health initiatives, national headlines, and mounting political pressure, we just had the deadliest year on record. Data from the CDC shows over 100,000 drug overdose deaths expected in the US in 2021, with two-thirds of that number driven by synthetic opioids. And that’s likely an undercount.
That’s more than twice as many deaths in 2021 as those caused by car accidents and gun violence combined.
It’s a new record high, with overdose deaths jumping 28.5% since 2020 and nearly doubling over the past five years. Add that to the 932,364 Americans that have died from fatal overdoses from 1999 through 2020, according to the National Center for Health Statistics, and it paints a grim picture of our nation’s failed war on drugs.
Young people, in particular those aged 15-24, saw the biggest year-to-year increase of fatal overdoses with deaths up 49% since 2020.
US Drug Overdose Deaths Since 2015. Source: National Center for Health Statistics
Experts point to the Covid-19 pandemic and the rise in the use of fentanyl – a synthetic drug that’s stronger and faster-acting than natural opiates – as key contributors to the rising overdose death toll. It’s no surprise that in the two years since the pandemic up-ended Americans’ lives, more of those already taking drugs started taking higher amounts, and more of those in recovery relapsed.
To make matters even worse, due to restricted international travel, hyper-concentrated synthetics (ie fentanyl) became the opioid of choice to smuggle across borders. Fentanyl is now so ubiquitous in the US that in 2021 the federal government seized enough of it to give every single American a lethal dose.
Last month the Biden administration called the opioid epidemic “a national crisis” that “knows no geographical boundaries, and it continues to get worse.”
Even if Covid disappeared tomorrow, we’d still have a massive problem.
Re-Thinking How We Treat Pain
The opioid epidemic began in the late 90’s when the pharmaceutical and health care industries started aggressively marketing and prescribing highly-addictive painkillers. Long-term prescriptions of hydrocodone and oxycodone became the norm for pain management, even without good data supporting the trend. But the problems connected with that trend weren’t taken seriously until overdose death rates began skyrocketing in the 2010’s.
In the search for a quick fix, mainstream medicine abandoned age-old, evidence-based treatment for pain in ways that didn’t happen in other areas of modern healthcare.
Treating pain, in general, is an incredibly challenging task. It’s not like managing hypertension or diabetes – there aren’t objective lab values or blood pressure readings to use as a guide. Physicians essentially have to trust the patient to tell them how much pain they’re in.
Even when a patient is being honest and cooperative, there can be plenty of other barriers that lead to inconsistent treatment, especially if it’s a new patient who doesn’t have a relationship with the provider or if there’s a language barrier.
That lack of clarity has contributed to the over-reliance of pain management physicians on simply prescribing happy pills and walking away. Especially for musculoskeletal problems like chronic back pain, they’re extremely common, with almost 20% of patients receiving long-term opioid prescriptions. That’s a problem since about 1 in 4 Americans prescribed opioids misuse them, and 8% to 12% of them end up developing an opioid abuse disorder, according to a 2015 study published in the journal Pain.
Pain Management: Changing How We Utilize Opioids
The fact is that all opioids really do is numb pain. They do this by attaching to proteins called opioid receptors on nerve cells in the spinal cord, gut, and other parts of the body. When this happens, pain messages are blocked from being sent to the brain.
But new studies are now showing opioids aren’t actually all that effective for relieving musculoskeletal pain long-term. A 2018 randomized controlled trial published in JAMA was the first to compare the effectiveness of opioids versus non-opioid medications (such as ibuprofen or acetominophin) for chronic low back, hip, and knee pain.
After a year of treatment, the researchers found opioids did not improve patients’ function any more than non-opioids. In fact, the patients on opioids were actually in slightly more pain compared to the non-opioid group (the result of something called “opioid-induced hyperalgesia” — increased pain sensitization brought on by these drugs).
Opioids don’t fix the cause of a patient’s pain, as other treatment methods are proven to do. Chiropractic, physical therapy, myofascial treatment – they all still work, even if they’re not as easy as swallowing a pill.
Just last week, the journal Chiropractic & Manual Therapies released extensive retrospective data demonstrating more of what we already know: chiropractic care substantially reduces the need for opioids. Among patients with an opioid prescription who saw a chiropractor for treatment, just 3.7% had to refill their prescription within 6 months of their initial visit. That’s compared to 14.4% of those who went the medical-only route for treatment.
Chiropractic vs. Conventional Care: Opioid Prescription Fills After 6 Months. Source: Chiropractic & Manual Therapies
The Bottom Line On The Opioid Crisis
There needs to be a total shift in mindset about how opioids are used in medicine. For extreme short-term pain, like the kind following a surgery, opioids like hydrocodone or oxycodone at the lowest effective dose might be the right choice. But as healthcare providers, we need to move away from using opioids to treat long-term, chronic pain as quickly as possible.
Additionally, there’s a disconnect between what insurance providers will cover and what actually fixes what’s causing a patient pain. It’s still much easier to get coverage for an opioid prescription than to get chiropractic, physical therapy, or active rehabilitation reimbursed – and as more research shows what works and what doesn’t, we need to push for that to change.
The Ascent Chiropractic Difference
Suffering from chronic pain and searching for a Brookfield, WI chiropractor? To get started, make an appointment at Ascent Chiropractic in Brookfield by calling 262-345-4166 or schedule an appointment with our online scheduling app.
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