Categories: General
      Date: Jan 15, 2011
     Title: Opiate Addiction Hits Home
An Open Letter to Providers from Dr. Augustine Chavez, of First Choice South Valley Health Commons and Tammy Berry, third-year medical student at UNM.

Last week Albuquerque news stations reported the first drug related tragedy of 2011.  A few days after the New Year, a local high school football player described as "funny, kind, smart, gentle, polite, and faithful,” died of a suspected unintentional oxycodone overdose.  Unfortunately, this story is representative of a rapidly growing problem of prescription drug related deaths in high school students. New Mexico has one of the highest drug-induced death rates in the nation with unintentional drug overdose accounting for more than 80% of drug-induced deaths. It is commonly thought that drugs such as heroin and cocaine are the culprits in overdose deaths.  However, between 2004 and 2008, over half of overdose deaths (58%) were caused by prescription opioids such as oxycodone, Percocet and Lortab.
Addiction to prescription opioids has become more common than addiction to all other illicit substances.  Nationally, an estimated 2.2 million Americans aged 12 and older began the non-medical use of prescription pain medications, surpassing the number of new marijuana users (2.1 million).  In 2005, more than 6 million Americans reported current non-medical use of prescription drugs.  This was more than the number using cocaine, heroin, hallucinogens, and inhalants combined.  Potential reasons for the rise in prescription opioid abuse compared to other drugs are the common perceptions that because doctors prescribe them, opioids are somehow safer, less stigmatizing and less likely to create problems with the law. Prescription opioids are also more readily available than other drugs, frequently found in the medicine cabinets of family members.  
The prevalence of opioid drug abuse is very concerning and should prompt us in the medical profession to reassess our role in this problem.  For years we were told that as medical providers we were under-treating pain.  Simultaneously, pharmaceutical companies began aggressive marketing of prescription opioids. This resulted in an explosion of opioid prescriptions in the last 10 years, leading to current estimates that 80% of the world’s opioids are prescribed in the United States.  Hydrocodone has become the single most commonly prescribed medication in the United States.  While pain certainly needs to be appropriately addressed in those we treat, it is increasingly evident that prescription opioids are not the answer.  Recently, the efficacy of opioid pain medications has seriously been called into question. Current research suggests opioid pain medications may be harmful in long-term treatment of non-cancer related pain.  
At First Choice we offer many non-opioid pain treatment options including non-narcotic prescriptions, participation in project ECHO which offers expert consultation for chronic pain patients, and treatment in our Chronic Pain Clinic which offers non-pharmacologic interventions such as trigger point injection, massage and stress reduction.  
For those few patients who do receive opioids we practice responsible prescribing.  We utilize the Physician Monitoring Program to identify patients who are obtaining prescriptions from multiple sources or “doctor shopping.”  We require patients and providers to sign Controlled Substance Use contracts.  We also follow the recommendations of professional groups and try to limit opioid prescriptions to the shortest duration possible.
We are working to prevent addiction to opioids by treating pain in different ways and practicing responsible prescribing.  We also offer treatment for patients who are addicted to narcotics.  We offer opioid replacement therapy in a rehabilitation model coupling Suboxone and counseling services for patients who need help overcoming addiction to prescription narcotics.  
As medical providers, it is our responsibility to prevent the increasing problem of prescription opioid addiction.  Unlike other illicit drugs such as heroin and cocaine, physicians are the source of these dangerous medications.  Although doctor shopping and Internet prescriptions are often cited as significant sources of inappropriately obtained opioids, prescriptions from single providers are by far the most common source of these drugs.  More than 80% of people abusing prescription narcotics obtain the medications either directly or indirectly from one prescriber.  
Hopefully, by recognizing the problem of prescription opioid abuse, accepting our role in it and actively addressing it we can help prevent further unnecessary and tragic deaths.   

Tammy Berry, MS3
UNM School of Medicine

Augustine Chavez, MD
First Choice South Valley