Peled Migraine Surgery Blog

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CHRONIC PAIN AND THE OPIOID EPIDEMIC, PART I

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I was recently invited to attend a meeting on the use of multimodality therapy to decrease the use of opioids in the US population.  Unless you’ve been away on a remote island for a long time or completely eschew any sort of media including newspapers and TV, you’ve probably heard that we have a problem with opioid use in this country.  I knew the numbers were bad, but frankly I came away from this meeting completely floored. Here are some statistics that should make you pause and take notice:

1. Americans account for only 4.6% of the world’s population yet have been consuming 80% of the world’s opioid supply and 99% of the world’s hydrocodone supply. 

Pain Physician. 2012; 15(3 suppl):ES9-ES38.

2. 1 in 15 patients will become chronic opioid users after surgery. 

Carroll I, et al, A pilot study of the determinants of longitudinal opioid use after surgery. Anesth Analg. 2102; 115(3): 694-702.  NIH, National Institute on Drug Abuse. Prescription and over-the-counter medications. Drug Facts. Revised Nov 2015. http://www.drugabuse.gov/publications/drugfacts/prescription-over-the-countermedications. Accessed 08/24/16.

3. 1 year following elective cervical spine surgery, approximately 1/3 of all patients were still using opioids.  

Wang M, et al. Predictors of 12-month opioid use after elective cervical spine surgery for degenerative changes [abstract]. Spine. 2103; 13(suppl): S6-S7.

4. 3 out of 4 people who misuse prescription painkillers,use medication that had been prescribed for someone else. 

Manchikanti L, et al. Opioid epidemic in the United States. Pain Physician. 2012; 15(3 suppl): ES9-ES38.  Office of National Drug Control Policy. 2013 Drug overdose mortality data announced: prescription opioid deaths level; heroin-related deaths rise[press release]. 01/12/15. http://www.whitehouse.gov/ondcp/news-releases/2013-mortality-data. Accessed 08/24/16.

5. Abuse of prescription painkillers like Oxycontin and Vicodinleads to eventual heroin use in 14% of people.

Busch S, et al. Abuse of prescription medication risks heroin use. Infographic created for: National Institute on Drug Abuse. http://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medication-risks-heroin-useAccessed 08/24/16.

6. In 2012, 259 million prescriptions were written for opioids in the US. This number represents enough narcotics so that every American could have a full bottle of pills sufficient to take 5 mg of hydrocodone every 6 hours for 45 days.

7. The problem is obviously worse in some parts of this country than others.  For example, 1 in 6 PEOPLE (not patients, people!) in the state of Tennessee are on opioids. (Presentation at this meeting)

Obviously, given the scope of the problem, you might suspect that there is no one or easy answer and you would be correct.  There is plenty of blame to go around on all sides of this major issue, but that also means there may be many avenues from which to address the problem. The people in the conference today are at the forefront of this epidemic and have a number of interesting ideas and strategies as to how to begin to tackle this problem.  Stay tuned….

THE TEAM APPROACH
The Headache Pain Caused by the Common Cold
 

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Tuesday, 22 May 2018

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