Whose Fault is the Opioid Epidemic?
The other day I was driving to work, listening to a podcast
that was discussing their view on the cause of the opioid crisis. The discussion went on to talk about the
Sackler family, who own Purdue Pharma and are the makers or OxyContin. In 1996, when this prescription medication
was approved by the Food and Drug administration, it was cited as a medical
breakthrough in long-acting pain treatment.
Today; however, this drug is quite often pointed to as ground zero for
America’s opioid epidemic.
This particular podcast went on to further raise the
question of responsibility.
Specifically, “What responsibility do private companies have in fixing
problems they effectively helped cause?”
Furthermore, they were questioning the integrity of Purdue Pharma for
their part in helping to identify potential treatments to opioid
addiction. The speaker stated that it is
similar to an arsonist coming up with a novel approach to putting out their own
fire.
As an informed pharmacist, who began pharmacy practice well
before the opioid crisis began, I am frustrated at this limited and uninformed
view of the cause of the opioid crisis.
As you will see, Purdue Pharma’s production of the opioid pain killer,
OxyContin, was not the cause of the opioid crisis, but only a reaction to
mounting pressure. During the late 80’s
and early 90’s, as evidenced by the increasing number of patient satisfaction
surveys, our nations medical staff were perceived as being insensitive to the
pain needs of their patients in hospitals.
During the first half of the 1900's and back through the
1800's, the majority of physicians viewed pain as an integral component of the
healing process. During the second half of the 20th Century, this all began to
change. Through a series of events,
which I will attempt to document for you here, physicians began to listen to
patients when they stated they were in pain.
In 1973, a landmark study documented that 73 percent of
hospitalized medical patients suffered from moderate to severe pain. During the similar time frame, an industrious
and informed physician began the process of patient satisfaction survey
development. The question was, how can
interviewing patients, at discharge from a hospital, potentially improve
performance of care?
By 1985 patient satisfaction surveys had begun, and the
results were clear that patients who were provided a positive experience were
more likely to have positive clinical outcomes.
This foundation of surveys helped hospital executives realize that in
order to improve quality, increase market share and optimize reimbursement they
must align all aspects of the organization in an effort to improve and manage
performance.
Through the 1990's, much emphasis was put on the development
of acute pain clinical treatment guidelines, laying the foundation for current
pain treatment. As any good company
would do, pharmaceutical companies had their ear to the train tracks and heard
the rumblings of the nation’s medical community. The response was the FDA’s approval of
OxyContin in 1996, followed by a variety of other long acting medications over
the following 15 years such as Avinza, Kadian, Exalgo, Opana ER, Hysingla and
Zohydro, just to name a few.
In 2002, the Hospital Consumer Assessment of Health care
Providers and Systems (HCAHPS), which had been developed in 2002 in joint
collaboration with the Centers for Medicare and Medicaid Services (CMS) in
order to rate hospitals, was formally endorsed by the National Quality Forum
(NQF) which is an organization established to standardize health care quality
measurement and reporting.
As I stated at the beginning, over the past 50 or so years,
physicians have begun to listen to patients with regards to pain. In addition to physicians listening to their
patients pain issues, patients are now able to evaluate, through patient
satisfaction surveys, just how well they are being treated for their pain while
in a hospital.
Be it right or wrong, evaluations such as these may influence
the corresponding hospitals reimbursement for the services provided by the
physician on staff at this hospital.
These evaluations may have the potential to influence how a physician
may alter their practice at a given institution. It is not inconceivable that a physician who
denies requests for opiate pain medication may not receive favorable ratings at
that particular institution, which, may impact their hospital privileges.
It is easy and simple to point our finger at one specific
drug company as the cause of our current opioid epidemic; however, as we all
know, things are rarely that simple.
Yes, perhaps the drug companies should have done further research as to
the potential risks of these long-acting opioid pain treatment options, but
they are definitely not the only ones to blame.
Remember, our very own Food and Drug Administration approved
these medications, our Medicare administrators implemented satisfaction surveys
that determined reimbursement for our hospitals, our hospitals required pain
treatment education for their physicians, and patients would have not received
any of these medications if pharmacists had not filled the prescriptions.
We now realize that opiate pain medication does have an
important role in both acute and chronic pain treatment; however, non-narcotic
alternatives, used in conjunction with opiate medications, may help to provide
reasonable pain control while decreasing the need for an increased dose of
opiate therapy.
Steve
Well said Steve! The opiate epidemic cannot be blamed on one person or company. It is the result of many factors.
ReplyDeleteGreat point about surveys. I believe too much emphasis had been placed upon eradication of pain as opposed to managing it. Oxy seems to have created an addictive bridge in conjunction with patient satisfaction surveys by influencing how doctors prescribe medication for pain.
ReplyDeleteThere is definately a lot to learn about this subject.
ReplyDeleteI like all of the points you made.