“I think there's a need for a more aggressive public health response,” Saloner said.
The Hopkins study noted an increase in people receiving inpatient services and treatment at doctors' offices. Saloner wrote that physicians in outpatient settings could be prescribing buprenorphine to treat opioid dependency, but he added how medication-assisted treatments are often unavailable in inpatient settings and could thwart patient recovery.
The newest findings come from data on the National Survey of Drug Use and Health administered by HHS' Substance Abuse and Mental Health Services Administration.
Comparing data from 2003 through 2013, the researchers found that the percentage of prescription opioids used nonmedically declined slightly. Frequent use increased from 14.2% of users to 19.3%.
The researchers reported that opioid-overdose deaths climbed from 4.5 deaths per 100,000 to 7.8 during the period studied. They also noted that the opioid crisis “has evolved over time” and has occurred during a simultaneous increase in heroin use and heroin-overdose deaths.
In the editorial, Nelson and his co-authors describe “a modern-day scenario” in which a person develops an opioid-use disorder after obtaining the drugs either legally or illegally, and then turns to heroin when their access to prescription opioids is lost.
“It was not like it was 20 years ago when you became addicted to heroin by using heroin,” Nelson said. “Nowadays, when you talk to these folks, almost all of them say they started with prescription painkillers.”
The study also noted that, in 2013, more than 75% of the individuals with opioid addiction did not receive treatment. This was confirmed in the other study conducted by researchers at Johns Hopkins University in Baltimore.
They found that about 16.6% of individuals with opioid-use disorders sought treatment from 2004 to 2008, compared to 21.5% for the next four years. While this may suggest an increase, Saloner said that, after the results are adjusted for demographic factors, the difference between the two numbers shrinks to an insignificant level.
The demographics of the opioid users have changed, so the original, unadjusted numbers were skewed by people using heroin, Saloner said. The “severity” of that population's condition drives more people to treatment. But, if you adjust for an apples-to-apples demographics comparison, Saloner said, “You're not seeing much of an increase at all.”
Although the most-recent data used in the study is 2 years old, Nelson said the findings are still relevant, and he didn't believe that more timely figures would affect the findings significantly.
Nelson said solving the addiction crisis involves treating pain with other methods besides opioids, for example using ice, elevation and compression.
“We're handing them this risk of addiction,” Nelson said. He added that, for chronic pain, ability to function is more critical than absence of pain. “I can get anyone down to a pain score of zero—but they'd be unconscious,” he said. “You have to be able to get up and go to work and participate in family and daily activities.”
An “information statement” released by the American Academy of Orthopaedic Surgeons echoed Nelson's sentiments.
In its statement, the AAOS noted that orthopedic surgeons are the third-highest prescribers of opioids and made several recommendations. These include using standardized opioid protocols, learning patient risk factors for addiction (such as depression), and adopting a culture change that shifts the focus of pain management away from opioid prescriptions.
“A culture change has created the current opioid epidemic, and only a culture change—led by physicians unafraid to limit opioid prescriptions—will solve the epidemic,” Dr. David Ring, a member of the AAOS Patient Safety Committee, said in a news release.