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Hello Health Care Transformation Tribe,

Last week, the Surgeon General Dr. Jerome Adams made an official announcement with recommendations to address the opioid epidemic in the U.S. He recommends more individuals keep the opioid antagonist, Naxolone, on hand in order to save someone from dying who is currently overdosing as well as provides recommendations to the general public and health providers about Naxolone and how to identify an overdose.

Let me give a quick recap on the epidemic and then I’ll give you my two-cents on the announcement along with some recommendations for you to follow in order to protect yourself and your loved ones.

Opioid Epidemic: Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin^®), hydrocodone (Vicodin^®), codeine, morphine, etc. Opioids have killed more than 250,000 people in the last decade, including more than 42,000 people in 2016 alone. That equates to one person dying every 12.5 minutes due to opioid overdose. Opioids kill an individual by depressing their respiratory function so the individual literally chokes to death because they cannot get enough oxygen to their brain and other organs.

Sadly enough, this problem is very unique to the U.S. in comparison to other countries:

Now you might notice a really interesting fact: many opioids, which lead to addiction and death, are actually prescribed to a patient by a doctor. The data show that most physicians lack confidence in their ability to prescribe opioids safely and to predict and discuss potential future drug abuse with their patients. And, in fact, large proportions of doctors are actually very concerned about opioid addiction and death.

My disappointment with the announcement is that there is such a focus on Naxolone, which is an expensive and often not readily available solution that doesn’t actually get at the root cause of the problem. The root cause of the problem is that doctors are prescribing high dosage and frequency of opioids to patients who unknowingly will get addicted and could have otherwise received a different pain intervention such as exercise, massage, acupuncture, physical therapy, etc. Unfortunately, once addicted patients turn to pill-seeking amongst different doctors to game the system and ultimately turn to getting heroin off the streets.

Therefore, it’s important that we stress the importance of educating physicians and patients on how to navigate this drug altogether to gain any potential benefit without wreaking havoc on an individual and their family.

For more background, I highly recommend the HBO documentary “Warning: This Drug May Kill You”.

The documentary will shake you to your bones but it will visualize for you how opioids can kill anyone from good kids to good mothers. 

Doctors can prescribe opioids on anything from knee surgery to a c-section. So how can you protect yourself and your loved ones?

When prescribed a pain-relieving medication, ask the following questions:

1. Is this medication an opioid?
2. Is there another option instead of taking a drug?
3. Is there a non-opioid pain-relieving drug I can take instead?
4. Is this the lowest possible dose I can take?
5. Can I have fewer pills?
6. How is it best to taper off the drug?

Be sure to discuss your health history, family history, and risk of addiction.

For the healthcare professionals, I recommend the following:

• Pull your analytics on prescribing patterns of doctors so you can intervene on high prescribers.
• Pull your data on dosage by patient so you know which patients are at risk of addiction and overdose.
• Use these guidelines to establish protocols and procedures for your institution in order to intervene where possible.

Yes, Naxolone has the potential to save an individual who is overdosing and going into respiratory failure, but we need to start addressing the root of the problem, which begins with developing clear guidelines and operational support to physician prescribers and patients.