President's Letter

Timothy P. Villegas, M.D.

Timothy P. Villegas, M.D. | President's Letter

By the time you read this article, the spring CME event focusing on the opioid epidemic will have taken place. I hope that many members were able to attend, and that the meeting will have stimulated dialog on how MCMS might collaborate to address opioid-related issues affecting our local community.

Americans consume more opioids than any other country. In 2012 there were over 259 million prescriptions written for opioid medications. In Georgia, opioid-related deaths have increased nine-fold over the last decade. Mortality due to opioid overdoses has now surpassed that of motor vehicle accidents, shootings and HIV. Over the past few years, the opioid epidemic has become a national-level issue. In response, legislators, medical organizations, drug retailers, pharmaceutical companies and care providers have all worked to take steps of varying degrees in an attempt to address the crisis. Of course, as with many complex problems, there are a wide variety of ideas as to how most effectively solve it.

In 2016, the CDC issued a guidelines regarding opioid use directed towards primary care providers. Most of these guidelines are common sense, including the main premise that pharmacologic (opioid) therapy should NOT be used first-line for chronic pain that is unrelated to cancer other terminal conditions. Other principles include the avoidance of extended-release formulations, using the lowest effective dosages, establishing clear treatment goals, limiting prescriptions for acute pain to no more than a three-day supply, and early and frequent followup to continually assess the risks and benefits of any long-term opioid use. This all seems very reasonable in my opinion, as did the development and implementation of the prescription drug monitoring program (PDMP). However, since it is estimated that over 2 million people in the U.S. already suffer from an opioid use disorder, it seems clear that directing resources towards education and addiction treatment programs will also need to be part of any solution.

That said, I wonder if certain reactions are going to swing the pendulum too far in the other direction, as often happens in response to crises. Last year, for example, Walmart instituted a corporate policy where they will no longer dispense more than a seven-day supply of narcotics to a patient, and they have arbitrarily limited maximum dosing to less than 50mg morphine equivalents per day. As this goes even beyond the CDC guidelines, the AMA and other organizations issued statements to address this policy in that it potentially interferes with and restricts the clinical judgement of healthcare providers and their ability to individualize patient care as needed. Will inevitable forthcoming reactive policy changes have a similar adverse impact on the ability to manage pain when clinically necessary? Time will tell, but the important thing is we as a community continue work together constructively solve this iatrogenic problem.