University of Utah’s Summit Addressed State’s Opioid Problem

On April 23, 2018, the University of Utah’s summit convened to discuss how to solve the state’s opioid problem.

The summit’s goal was to identify barriers faced by health care providers and others in providing effective treatment of pain and addiction. The participants’ diverse professional backgrounds provided an opportunity for a productive conversation.

Participants included physicians, pain specialists, addiction recovery therapists, child welfare advocates, pharmacists, defense attorneys, prosecutors, drug court representatives, poison control specialists, data specialists, public health officials, specialists in harm reduction, and many others who are involved in the opioid crisis.

Some participants were invited to provide brief comments on the crisis based on their unique perspective and expertise. I was one of those invited to offer a few comments.

Here Is My Message.

In October 2017, President Trump declared the opioid crisis to be a public health emergency. That was an important first step, but he missed a key point: the pain crisis is an integral component of the opioid crisis. We can’t solve the latter until we successfully address the former.

According to the National Institute of Medicine of the National Academies, 1 in 3 adult Americans experiences chronic pain. Approximately 1 in 5 people with chronic pain depend on medical therapies, including opioid therapy, to function.

Cultural attitudes towards people in pain have shifted in the past few years. In the 1990s and first decade of this century, most of society recognized that people in pain had been undertreated. It was broadly accepted that people in pain deserved compassionate care.

Today, there is indifference, or even hostility, towards people in pain. Often, people in pain and their doctors are blamed for the opioid crisis.

Primary care physicians now view treating chronic pain as a low priority or a burden. Even worse, they dread seeing a patient with chronic pain.

Increased regulatory and legal sanctions imposed on providers have created a fear of prescribing opioids and a perception of far more risks than benefits for the provider. Even compassionate doctors who were willing to prescribe opioids for chronic pain patients in the past are rethinking  their priorities.

Providers do not want to risk losing their license to practice medicine by continuing to treat their current patients with opioids. They are not eager to take on new patients whose pain treatment may involve opioids.

The physicians who are willing to treat pain with an opioid feel that, first and foremost, they must differentiate between patients who have a legitimate need for opioids and people with addiction. Trust between patients in pain and their health care providers has all but evaporated. That holds true whether or not opioids have been prescribed.

Barriers to effective care include political, payer, medical, and legal issues. The CDC Guideline for Prescribing Opioids for Chronic Pain has added to the stigma and created a barrier to providing compassionate care. Largely because of the CDC guidelines, patients are being involuntarily tapered or withdrawn from medication without any alternatives. Patients are being discharged from medical practices simply because they have pain.

Insurers play a role because they resist providing access to alternative evidence therapies. They insist that patients first try less expensive, less effective and, often, more dangerous options. Even then, effective opioid alternatives are difficult, or impossible, for many people to obtain.

That leaves people with pain in a difficult position. They are treated as drug abusers, malingerers, or criminals. Because of the stigma associated with needing opioids, many are experiencing enormous shame and embarrassment. 

Many patients are being abandoned by their doctors, and they are forced to seek drugs from the street to help manage their pain. Some even turn to heroin or other illegal drugs. They may experience isolation, hopelessness, and depression. They risk becoming entangled in the criminal justice system. Finally, suicides are increasing among people who cannot find relief.

Solutions lie within the political, payer, medical, and legal will to change the culture and reverse the impact of misguided policies.

It begins with us. We, as members of our community, must work together to curb the opioid crisis without forgetting people in pain.

There Is Reason for Hope

Time will tell if the summit leads to solutions. We should be encouraged that there was an effort to hear each other’s concerns and, as a community, work to solve the dual healthcare crises of our time: pain and addiction.