A Note to Hillary Clinton: Please be Responsible with Opioids

While Presidential candidate Hillary Clinton only recently announced her bid for office in 2016, she has already declared a few important issues on her presidential agenda, including the ever-important opioid crisis in the United States.

Many are chiming in to offer their best solutions to curbing the opioid abuse epidemic; sadly, many of the proposed solutions fail to promote and fund safer alternative therapies for people suffering from chronic pain who rely on opioids to live a semblance of a normal life.

I applaud Clinton’s desire to work toward a safer, opioid-free world. It’s a goal we should all aspire to. In order to realize it, however, we must not forget those people who rely on opioids to get through the day in the absence of alternative treatments.

Here is what Hillary Clinton must consider as she seeks to curb opioid abuse:

Redefine the prescription opioid problem as the chronic pain problem

Prescription opioids have garnered a great deal of attention for the possible health risks involved in taking the drug. While it is easy to get caught up in the whirlwind of bad press, it is still important to remember why opioids are such a prominent treatment form in the first place. More than 100 million people in the United States suffer from chronic pain, meaning a third of the entire country may rely on some form of medication to make their lives better. Pain ranges in severity, with many suffering from severe pain that makes it difficult to live a normal life. While no medical professional advocates that opioids should be the first line of defense, in some cases, they happen to be the only thing that works for a patient. Trying to end opioid abuse without addressing the needs of those who rely on the drug may make the problem of chronic pain worse.

Understand why prescription opioids have risen in popularity

In 2007, Americans spent $34 billion in out of pocket expenses to cover the cost of alternative forms chronic pain treatment.  To be clear, opioids are not the only means of treating chronic pain. Alternative therapies exist, but are woefully underfunded by payers. As a result, many patients with severe chronic pain, those who struggle to get out of bed, who sometimes lose their jobs, must rely only on what their insurance covers – in most cases, that form of treatment is opioids. The chronic pain community needs access to safer alternative therapies. We need to invest in research to bring even more alternative therapies to the market, and crucially, insurance companies must then cover those alternative forms of care. In 2012 the National Institutes of Health (NIH) spent only about 400 million dollars on chronic pain conditions but more than 2.5 billion dollars was spent on drug and other substance research.  We certainly need to find safer and more effective therapies for addiction but some of the current cost associated with substance abuse it due to the limited options to treat the number one public health problem in America: pain.

Stop stigmatizing patients who currently rely on opioids

Alternative forms of medication that could potentially help chronic pain patients and decrease the demand for opioids remain underfunded and under-researched. Despite being one of the largest health researchers and sponsored by the U.S. Department of Health and Human Services (HHS), the NIH continues to operate on a shoestring budget. Despite the lack of options for alternative therapies for chronic pain, the topic of opioid abuse has become a popular topic in the media, and sadly, caused an increase in stigmatization of patients who use opioids for pain management. Patients have reported reluctant doctors and pharmacists unwilling to prescribe necessary medications. The DEA has rescheduled hydrocodone as a Schedule II drug, leading to a series of unintended consequences with which patients today are left to suffer. Many patients report feeling like drug addicts for simply trying to fill their legally obtained prescriptions.

Require all opioids to be abuse-deterrent

Abuse deterrent formulations (ADF) have been shown to curb some forms of opioid abuse, while maintaining the benefits for patients that need the drug.  Unfortunately payers have priced these safer formulations so that there is little incentive for market adoption.  HHS should lead the way and negotiate deals with manufactures to make ADFs no more expensive than generic alternatives to patients.

Remove methadone as a “preferred” drug

While the use of methadone as an analgesic for chronic pain has expanded in recent years, it shows up in mortality reports with a higher frequency than other opioids. Despite the evident risk associated with this drug, many states have listed it as a “preferred” analgesic in treating severe chronic pain, largely due to its low cost and savings for publicly funded health plans. The American Academy of Pain Medicine holds that methadone should not be a preferred drug unless special education is provided, and that it should never be the first choice in treating chronic pain.

The opioid crisis is not a black and white issue. Until we stop treating it as such, we will not be able to tackle the problem at its root. Eliminating opioids does not alleviate the problem, end patient suffering or acknowledge what the true issue is. Millions of Americans suffer from chronic pain, but very few have access to multiple options to manage their pain.

Through an increase in funding and research of alternative therapies, implementation of ADF’s and greater coverage by payers, we can finally begin to treat the opioid epidemic in a safe and responsible way – a way that does not hurt the millions of Americans who rely on opioids to get out of bed, to play with their children, to get through the day.

2 thoughts on “A Note to Hillary Clinton: Please be Responsible with Opioids

  1. Thank you for standing up and educating the “powers that be” to understand the difficulties of the chronic pain patient.
    I unfortunately missed your lecture this past Saturday, April 30th in Warren, Mich due to my FM. In my former life I was a clinical/medical social worker, I loved my work ,my patients adored me. I was well known for my ability to speak publicly and was recruited to be on boards, engage in community involvement. My illness frustrates me in that I am unable to be a great advocate for my fellow brothers and sisters. So I am ever so thankful that others are doing good works,fighting for our rights and educating those who are uninformed.

  2. I agree with almost all your recommendations, Dr. Webster. But I take issue with the abuse deterrent formulations being MANDATORY. Many medications already have a pretty short half life (roughly 4 to 5 hours max) and many of them are not 100% easily absorbed. Add to that individual absorption issues, AND individual dosage requirements (ex. some patients do ok with a 5mg but others need a 10mg ) and interferences with the absorption of these medicines could increase and present new under treatment issues.
    I would agree however with these new formulations to be first line medicines for the AT RISK population of pain patients who have some past and/or observable risk factor/s of abuse and addiction. But not for the vast majority of patients who do not exhibit any addiction tendencies.
    Also add in the cost factor, and these medicines, of which may not have a Generic brand available, could now be completely out of reach for the pain patient, most of whom have very limited finances.
    Current formulations of many longer acting opioid pain medicines have considerably high copays, and frankly many pharmaceutical manufacturers DON’T WANT generic versions of their very profitable, yet oddly very difficult to obtain, long acting medications.
    To make the distinction to make these abuse deterrent formulations MANDATORY would be a very damaging action, to a population who largely does not need them, and most probably will not be able to afford them.

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