In a crisis, words are simply not enough. Our country must have bold leadership and the commitment to follow through with bold action.
The opioid epidemic is no different. President Donald Trump has made powerful statements about the negative effects of opioid overuse in our country in terms of precious lives lost and cost strains to the healthcare system. He declared it a public health emergency, set targets for reducing overdose deaths, and, above all, made clear the need to "use every resource at our disposal to release the grip of addiction plaguing our citizens." Unfortunately, the crisis continues in communities across the country. More than ever, the federal government must follow through on its commitment to end the epidemic and dedicate resources to areas that can make the most positive difference.
This is a mighty challenge: The Centers for Disease Control and Prevention estimates that there were more than 191 million opioid prescriptions in the U.S. in 2017, even though the number of prescriptions has been falling since 2012. So it's hardly surprising to learn that as many as 92% of patients report having excess opioid pills following a surgical procedure.
We can tackle this problem strategically by targeting the source of unnecessary patient exposure to opioids and ridding our communities of excess pills. More than 100 million surgical procedures are performed annually in the U.S. The vast majority of patients–80%–are prescribed opioids to manage their perioperative pain.
The overprescribing of opioids leads to two bad outcomes. First, most patients do not complete their full prescriptions, nor do they properly dispose of the excess pills. Instead, these pills sit in medicine cabinets and become available for diversion or misuse. According to data from the Annals of Internal Medicine, nearly half of all episodes of opioid misuse occur by obtaining prescription opioids from friends or relatives.
Second, patients may continue to take their opioid medications unnecessarily, putting themselves at risk of dependence or addiction. Each year, nearly 3 million patients become newly persistent opioid users after surgery, meaning they are still taking opioids three to six months after their procedure.
To prevent the overprescribing of opioids and reduce rates of related addiction, there are non-opioid therapies and approaches offered by a wide array of healthcare professionals that can make a significant difference. These approaches can effectively manage pain, reduce opioid consumption, and improve outcomes after surgery—but they need to be better incentivized to make them more widely available to patients.
An evidence-based technique for reducing unnecessary opioid use is promoting multimodal pain management protocols that prioritize non-opioid therapies. Providing patients access to all medically appropriate alternatives, including IV NSAIDs, long-acting local anesthetics, and therapeutic services like physical therapy, acupuncture and massage therapy, can reduce perioperative and post-surgical opioid consumption by as much as 90%.
Recently, our organizations joined 23 leading groups encouraging the CMS to incentivize the utilization of non-opioid pain approaches through better reimbursement strategies. Fortunately, Congress is taking notice.
To ensure all patients can access these approaches, including patients in hospital outpatient settings where most outpatient surgeries are performed, Reps. Terri Sewell (D-Ala.) and David McKinley (R-W.Va.) late last year introduced the Non-Opioids Prevent Addiction in the Nation Act (HR 5172). The NOPAIN Act is a bipartisan solution to improve reimbursement policies for non-opioid products. Ultimately, the legislation will reduce the number of opioids prescribed by helping more patients and healthcare providers access alternatives that manage pain in a safe and effective way.
In order to address the ongoing opioid epidemic more effectively, we must do everything possible to prevent people from becoming addicted in the first place. Such "upstream" approaches are absolutely vital for saving lives and improving the health of communities across the country. We urge Congress to quickly pass the NOPAIN Act.