The United States is currently in an epidemic that is often referred to as the “opioid crisis.” This has led to a change in the availability and access of opioid-containing pain medications to individuals battling chronic pain.
What is are opioids?
The term opioid refers to a class of drugs that act on opioid receptors in the body. These receptors help control pain and often produce pleasure. This is why opioids can be addictive. Opioids can be legal and prescribed by a doctor, such as oxycodone, codeine, morphine, and hydrocodone. Other opioids, including heroin, are illegal. The drug fentanyl is a synthetic (or man-made) opioid drug.1 Fentanyl can be prescribed and regulated by medical professionals, however, it can also be illegally made and manufactured. Illegally produced fentanyl can be extremely potent, and very small amounts can lead to an overdose. Illegally created fentanyl can also be laced or put into other illicit drugs, which can make them even more dangerous.1,2
What is the opioid crisis?
According to the Centers for Disease Control and Prevention (CDC), in 2016 alone, nearly 12 million Americans aged 12 and older said they had misused an opioid within the last 12 months.3 In addition, it has been estimated that around 115 Americans die each day due to an opioid-related overdose, and 350,000 individuals have died between 1999-2016 as a result of an opioid-related overdose.4,5 These numbers are several of the many statistics that have led experts to believe that opioid misuse is currently a national health crisis.
The opioid crisis is thought to have grown in three waves. The first was in the 1990s with the introduction of opioids to the market, and a lack of awareness on their addictive properties. The second and third waves came in 2010 and 2013, as heroin and illegally-made fentanyl gained popularity as street drugs.2,4,5 In order to combat the opioid crisis, many national, state, and local organizations have created programs designed to help those who are addicted, educate others on addiction, fund research into alternative pain relief options and addiction medicine, and set stronger regulations on opioid prescribing.
How is the opioid crisis changing access to medications?
As mentioned, many regulations and organizations are being created in the United States to help fight the opioid crisis. As of late 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act has been passed that will provide resources to expand research, regulation, and support for those affected by the opioid epidemic, and to prevent its further spread.6 However, aside from this national act, the majority of regulations around opioid prescribing are at the state level. Some states have well developed and strict regulations for who can prescribe opioids and in what context, while other states have none. If you live in a state with strict regulations, it may be harder to gain access to these medications.
In order to create a more standardized method of prescribing opioids, the CDC has created a set of guidelines for providers to use when considering a potential opioid-containing treatment plan for an individual in pain. There are 12 guidelines in total, and include recommendations such as checking the PDMP (prescription drug monitoring program) database to check an individual’s current prescriptions across their area, starting with the lowest dosage of opioids possible when starting treatment, and maintaining a close follow-up schedule to determine if the harms of treatment are ever outweighing the benefits.7 Due to the opioid crisis, many providers will try to find alternative methods of long-term pain relief before creating a plan that includes opioids.
Non-opioid pain relief options
As mentioned, opioids are not meant to be the first option for pain management. If this is the first time you and your provider are working together to create a pain management plan, it’s possible that they may first suggest starting with non-opioid pain relief alternatives, or using non-opioid pain relief options in addition to opioid therapy. Some of these options include, but are not limited to:
Antidepressants (tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors)
Topical agents (lidocaine)
Opioids. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids. Accessed December 1, 2018.
History of the Opioid Epidemic. Poison Control: National Capital Poison Center. https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182. Accessed December 1, 2018.
2018 Annual Surveillance Report of Drug-Related Risks and Outcomes: United States. Centers for Disease Control and Prevention: US Department of Health and Human Services. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. Published August 31, 2018. Accessed December 1, 2018.
Opioid Overdose: Understanding the Epidemic. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/epidemic/index.html. Published August 30, 2017. Accessed December 1, 2018.
Opioid Overdose Crisis. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Published March 2018. Accessed December 1, 2018.
The SUPPORT for Patients and Communities Act (H.R. 6). American Society of Addiction Medicine. https://www.asam.org/advocacy/the-support-for-patients-and-communities-act-(h.r.-6). Accessed December 1, 2018.
Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf. Accessed December 1, 2018.
Nonopioid Treatments for Chronic Pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/pdf/nonopioid_treatments-a.pdf. Published April 27, 2016. Accessed December 1, 2018.