Introduction

According to a recent study, 2 out of every 3 people receiving medications to treat their opioid addiction continue to be prescribed painkillers after completing treatment. This creates a potential hazard, because it leaves the door open for a possible relapse.

The reason for this is that people who were once addicted to opioids have experienced changes to their brains that make them forevermore extremely vulnerable, at any dosage. Even therapeutic doses can complicate recovery and jeopardize their sobriety.  In this way, researchers say, opioid addicts are like alcoholics who should never drink again.

Just as concerning, however, is the fact that over 40% of patients who are currently taking the anti-addiction drug buprenorphine also take an opioid pain medication.  This interaction could potentially counteract the treatment they are receiving.

In other words, doctors are giving opioid painkillers to the very group of people who should not be receiving them.

The researchers say there is no valid medical reason why both types of medication should be prescribed at the same time.  But Dr. Caleb Alexander, who directed the study, says, “The statistics are startling but are consistent with studies of patients treated with methadone showing that many patients resume opioid use after treatment. But the high rates of combined use of buprenorphine and other prescription opioids is cause for concern.”

These findings raise serious questions about how some American physicians are not following established guidelines and how they are not using some of the tools they have at their disposal. And those errors may be one of the major factors behind the continuing—and worsening—opioid crisis in this country.

How Bad Is the Opioid Problem in America?

“One of the most heartbreaking problems I’ve faced as CDC Director is our nation’s opioid crisis. Lives, families, and communities continue to be devastated by this complex and evolving epidemic.”

~ Dr. Thomas Frieden, then-Director of the Centers for Disease Control and Prevention

The American drug crisis is worse than at any other point in our history.

The Centers for Disease Control and Prevention reported 72,300 drug overdose deaths in 2017—an all-time high. To put that in perspective, in 1999, there were “only” 16,849 drug deaths, and that number has increased every single year. Every year, a tragic new record is set.

Within a single 20-year generation, the number of fatal overdoses has skyrocketed 429%.

Most of those deaths involved opioids – prescription pain medications, resurgent heroin, and with increasing frequency, super-powerful illicit synthetics such as fentanyl.  In fact, over two-thirds of all drug poisonings are opioid-related.  In 2017, that worked out to approximately 49,000 opioid drug deaths.

Opioids claim an average of 115 American lives per day.

Some experts believe that it’s going to get worse before it gets any better.  It is estimated that between 2015 and 2025:

• The number of opioid-related deaths will spike sharply, rising from 33,100 to 81,700.
• That is a 10-year jump of 147%.
• 700,000 people will die because of opioid overdoses.
• 80% of those deaths will be due to heroin or fentanyl.
• Illicit opioid deaths will continue to surpass those from prescriptions, climbing from 19,000 to 68,000.
• That is an increase of 260%.

Addressing the Changing Problem

At first, it is difficult to comprehend.  Opioid deaths are continuing to rise even though a number of significant steps have been taken:

• Expanded campaigns aimed at increasing public awareness
• New federal prescribing guidelines
• Shareable physician databases
• Greater availability of Narcan
• Needle exchange programs

The primary issue is that not all of these measures are being employed across-the-board.  Different states and even individual cities have their own way of dealing with the problem.  Of even more concern is the fact that even when there are programs in place, established best practices are always being followed.

Dr. Lawrence Brown, an addiction expert located in New York City, says, “The driving force isn’t the CDC, it’s the states.  States are the ones that license doctors, but state regulations tend to lag behind Federal guidelines.”

Problem Prescribing Plays a Role

“Individuals were prescribing drugs without even performing a history and physical exam. They never did any kind of testing, they didn’t provide informed consent. They don’t have a treatment plan or objectives. They just continue to prescribe and prescribe.”

~ Kim Kirchmeyer, Executive Director,  Medical Board of California

According to the National Safety Council:

• 99% of Us doctors exceed the federal recommendation of three-day prescription limits.
• Nearly three-fourths prescribe 30-day supplies.
• 55% of dentists and 70% of doctors give painkillers for dental and back pain, even though opioids are not the recommended first-line treatment for those problems.
• Good news—85% of healthcare providers ask patients about their personal history of Substance Use Disorder.
• Bad news—just 1 in 3 screen patients for a family history of addiction.
• When patients exhibit signs of prescription misuse, only 40% of providers provide addiction treatment referrals.
• Just 5% of providers offer direct treatment for SUD.

In fact, the overprescribing problem is so prevalent that in 2016, The U.S. Surgeon General, the Food and Drug Administration, and the CDC all recommended changes to the way that opioids are prescribed.

For a snapshot of how bad the problem can be, a 2012 investigative article in the LA Times, found that in four Southern California counties, over half of all accidental prescription deaths were among patients with a legitimate doctor’s prescription. The CDC estimates that just 15% of the prescriptions misused by “chronic abusers” come from illegal sources.

Coroner’s records in the Counties of Los Angeles, Orange, San Diego, and Ventura, and Orange revealed that during one 5-year period, 47% of fatal overdoses involved drugs for which the victim had a prescription that was later determined to be the sole or a contributing cause of death.

Of special relevance, a tiny fraction of all the practicing physicians in those four counties – just 0.1% – prescribed the drugs involved in 17% of the deaths. Among that 0.1%, each doctor had three or more patients who died.

Doctors May Face Charges

“(She) either didn’t know or didn’t care what she was doing.”

~ Oklahoma investigators talking about Dr. Nichols

But the tide may be turning against problem prescribers:

• In 2016, a doctor in Southern California was sentenced to 30 years to life in prison after being convicted of murder following the overdose deaths of three of her patients.
• Significantly, Hsiu-Ying “Lisa” Tseng had already been on notice from the Los Angeles County Coroner’s Office about three earlier patients’ deaths.
• In 2017, an Oklahoma doctor was with second-degree murder after five of her patients fatally overdosed.
• Between 2010 and 2014, Dr. Regan Ganoung Nichols prescribed more than 3 million doses of dangerous drugs.
• In 2018, a Queens doctor, Lawrence Choy, faced 231 counts, including reckless endangerment and manslaughter, after the overdose deaths of three patients.
• Choy routinely prescribed a dangerous drug combination of Oxycodone, Xanax, and Somo, a powerful muscle relaxant.
• Also in 2018, a doctor in Massachusetts, Richard Miron, was charged with involuntary manslaughter, illegal prescribing, and fraud after a patient overdosed on a combination of prescription drugs that included both morphine and fentanyl.
• Miron continued to dispense large doses to the patient, even after she had non-fatally overdosed on opioids he had prescribed.

DEA Agent Mark Normandy said, “One doctor can turn a town upside down.”