Commentary: Doctors must play leading role in battle against opioid abuse

The dosage was high, but the drug's effect on the patient's chronic pain was leveling off.

The danger of an overdose loomed. The patient, working with his doctors, decided to enter a detox center and transition off the opioid painkillers in a medically monitored environment.

After providing initial relief, the drug had become more of a risk than a benefit. The patient received both buprenorphine—used to treat opioid addiction—and psychosocial treatment. As with most chronic-pain patients, his symptoms improved once he got off the medication. And he has beaten addiction.

This is a real story and a far too common situation. The path to addiction often starts in a doctor's office. That's why doctors have to be front and center in the fight against opioid abuse.

Since 1999, there has been nearly a fourfold increase in the sales of prescription opioids. But pain has not quadrupled in America. While most of these prescriptions undoubtedly were written in good faith, there's no doubt some of these drugs are being abused. Combined with illegal drugs, they are fueling a 15-year increase in opioid overdose deaths nationwide. Across America, opioid-related deaths have increased by 200% since 2000. Northeastern states have been particularly hard-hit by the epidemic. Last year alone, 657 lives were lost in Connecticut—a grim all-time record.

Physicians must be more thoughtful and accountable in prescribing opioids. This is one of the goals of a bill just signed into law by Connecticut Gov. Dannel Malloy that establishes a seven-day supply limit for most initial acute- pain-related opioid prescriptions. It ensures that first responders have and know how to use drugs (such as Naloxone) that can halt a drug overdose and it prevents health plans covering such drugs from requiring prior approval. We applaud Connecticut officials for quickly turning sound policy into law.

Nationally, there have been two key efforts aimed at further enlisting the medical community in the struggle against opioid addiction. First, the Centers for Disease Control and Prevention recently released new opioid-prescribing guidelines that call for weighing the risks and benefits of opioid treatment more thoroughly than for less dangerous medications. The CDC calls out the dangers of higher opioid dosages or combining opioids with sedatives, and warns about using opioids to treat acute pain.

Opioids are highly effective at relieving acute pain, but that treatment is not risk-free. Many would forgo that relief if advised of the potential dangers.

Meanwhile, the medical community has recognized the need for a broader science-based focus on addiction in medical education. The American Board of Medical Specialties has recognized addiction medicine as a new subspecialty. This move and the new CDC guidelines provide incentives for healthcare networks to invest in addiction prevention and early intervention.

Our health system, Hartford (Conn.) HealthCare, has involved physicians—and all of our caregivers—in the cause of preventing and treating opioid addiction.

We have given providers additional education and tools to assist them in prescribing appropriate opioid dosages. In the past year, we have increased access to medication-assisted treatment and added a second position to our Addiction Medicine Fellowship. We helped develop the process to train Connecticut pharmacists in the prescription and use of Naloxone and worked with drugstore chain CVS, which has committed to having Naloxone on hand in its pharmacies.

There is early evidence that physicians are beginning to step up with regard to prescribing practices. The New York Times reported just last month that the number of opioid prescriptions has dropped for the first time in two decades. We hope that this trend is followed by a decrease in overdoses—especially fatal overdoses.

Doctors didn't start the opioid-abuse epidemic. But by working with patients, families and all the stakeholders involved in this complex issue, they can help end it.