As most of us are aware, the United States is experiencing an opioid epidemic. In 2017, there were 70,237 drug overdose deaths in the country, with two thirds of them associated with an opioid (Hedegaard, Minino, & Warner, 2018; Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). The age-adjusted rate of drug overdose deaths has risen from 6.1 per 100,000 in 1999 to 21.7 in 2017 (Hedegaard et al., 2018).

Although some of us would say, the epidemic does not affect my practice, or my patients are "different" and not involved with opioid dependency, the statistics say otherwise. There is no "typical" user or abuser. They come from all walks of life. Perhaps there was a surgical procedure, an accident, or chronic low back pain that precipitated a prescription for an opioid that escalated into misuse and abuse. According to data from the 2015 National Survey on Drug Use and Health, nearly one in three adults in the United States use prescription opioids, and of those, roughly 21%-29% of patients with chronic pain misuse them. Approximately 8%-12% develop an opioid use disorder (National Institute on Drug Abuse, 2018).

From 2010 to 2014, drug overdose deaths that involved at least one specific drug (on a death certificate) included the opioids, heroin, oxycodone, methadone, morphine, hydrocodone, and fentanyl; benzodiazepines, alprazolam, and diazepam; and the stimulants, cocaine and methamphetamine (Warner, Trinidad, Bastian, Minino, & Hedegaard, 2016). It is unknown whether the drug was a prescription misused by the patient, a diverted prescription, a drug bought off the street, and/or an illicitly manufactured drug (Seth, Rudd, Noonan, & Haegerich, 2018). In particular, illicitly manufactured fentanyl has become a significant factor in overdoses.

Some of our patients may be affected by the opioid epidemic. One example is a cancer rehabilitation patient. Oncology professionals are seeing more patients with cancer and concomitant chronic pain that has not been controlled, has been mismanaged, or managed with high doses of opioids. In addition, the number of people with a current or past substance use disorder (SUD), who now require cancer treatment, is increasing (Paice, 2018a). The prevalence of SUDs in patients with cancer is unknown; however, if 9% of all Americans currently meet the diagnostic criteria for a SUD, oncology practices likely provide care to some of those individuals (Paice, 2018b).

An article by Van Zee (2009) describes one factor that has influenced the opioid crisis. Van Zee writes about the aggressive marketing of OxyContin beginning in the late 1990s. In 2001 alone, the pharmaceutical company spent $200 million to market and promote the opioid. At the time, the pharmaceutical company reassured medical professionals that patients would not become addicted to this opioid, quoting statistics that the risk of addiction was extremely small and, in some publications, stated it was less than 1% (National Institute on Drug Abuse, 2018; Van Zee, 2009). As a result, there was widespread prescribing of the drug; however, before long it was clear that this medication was highly addictive. In 2007, the pharmaceutical company, along with three company executives, pled guilty to criminal charges of misbranding OxyContin by claiming that it was less addictive and less subject to abuse and addiction than other opioids.

In 2018, in response to the opioid epidemic, the American Academy of Physical Medicine and Rehabilitation revised their 2014 position statement on opioid prescribing. Recognizing that chronic pain affects more than 100 million Americans, the goal of the physicians in the American Academy of Physical Medicine and Rehabilitation is to avoid adverse events associated with opioid usage, including addiction, misuse, abuse, diversion, and death (Shaw et al., 2018). However, the organization does state that carefully selected patients can demonstrate functional improvements from a treatment plan that includes opioid medications (p. 681).

The opioid epidemic, it affects everyone.

CONFLICT OF INTEREST

The author declares no conflict of interest.

Pamala D. Larsen, PhD

Editor-in-Chief,

Loveland, CO, USA

References