ADDICTION AND SUBSTANCE ABUSE

When you think of drug addiction, what’s the first thing that comes to mind? The majority of us would immediately say that substances like heroin, cocaine, and even to some extent marijuana are the main causes of the problem.

    While these drugs are well known to that contribute to the problem of addiction in the United States there are unfortunately other substances that are just as problematic. In recent years we’ve been constantly bombarded with tales of doctors across the nation over prescribing opioids. It’s this easy access that can lead to misuse, addiction, and in some cases even the death of the patients, these deaths have reached epidemic levels within the past decade.

 

From 2000 to 2010, the rates of unintentional overdose on prescription opioids increased dramatically, accounting for more deaths than those attributed to all illicit drug categories combined (Washington, 2016)(CDC Vital Signs, 2011). Drug addiction is an issue that is growing with severity every day and can be attributed to over prescription of opioids, loose regulation guidelines from the U.S Food and Drug Administration agency (FDA) and miscommunication between health professionals.

 

    In West Virginia, a place considered to be at the epicenter of the opioid epidemic, Dr. Michael Kostenko currently stands under investigation, and is threatened with loss of his license after multiple reported deaths caused by his practice of over prescribing opioids to his patients. Dr. Kostenko is estimated to have written well over 40,000 prescriptions for opioid substances like Oxycodone, Vicodin, or Oxymorphone within the past two years. When interviewed, he was asked, “Did you write 325 prescriptions the first week of January for more than 19,000 oxycodone pills?” Dr. Kostenko replied “Possibly, it may well be.” (Axelrod, 2016) Unfortunately, Dr.Kostenko’s case is not a unique one. In West Virginia alone, seven doctors have lost their licenses and 15 more are currently being investigated. (Axelrod, 2016) In the United States as a whole, it was estimated in 2014 that U.S doctors wrote nearly 200 million prescriptions for opioid painkillers, while roughly 19,000 deaths linked to the drugs were reported.(Ballantyne, 2015)

 

While these numbers are alarming to hear, the bigger question is why are we as Americans so over prescribed painkillers? A clue is that some medical professionals, Kostenko included, believe that the heart of the problem lies in the fact that opioids are legal to prescribe and doctors do not consult with each other when issuing opioids as treatment.

 

Dr. Kostenko stands by his practice of prescribing opioids by saying, "With prescription drugs, physicians can prescribe them. They're legal. It's not like cocaine or heroin."(Axelrod, 2016) Many of today’s doctors share this ideology: they’re prescribing a legal substance designed to help their patients with issues like cancers, surgeries, and chronic pain.

 

In the 1990s, some specialists believed that doctors were under treating common forms of pain, from backaches to joint pain and something as common as arthritis, that could be easily remedied with the use of opioids. The idea was even further pushed by multi-million dollar promotional campaigns for new longer-acting drugs like Oxycontin that were touted as being less addictive.(CDC, 2016) With a great deal of vested interest in the administering of these opioids, pain specialists lobbied various states, medical boards, and multiple legislatures to lift the prohibitions on opioid use in the hopes that less strict regulations would be put in force.(Ballantyne, 2015) As young doctors began their practice, they were instructed to view pain as the “fifth vital sign” and were encouraged to address and aggressively treat pain in their patients.(Washington, 2016) At that time, it was not easy to see the eventual the impact those actions would have on opioid addiction the US has today.

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    Poor communication between health professionals is also a contributing factor as to why the United States, with only 5% of the world’s population, is consuming more than 80% of the world’s opioid supply.(Ballantyne, 2015) Some doctors are not talking with each other when it comes to prescribing proper treatments to their patients. In his interview, Dr.Kostenko specified that he didn’t consult with the primary care physicians of his patients and didn’t deem it productive to do so.(Axelrod, 2016)

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This is troubling, simply because if a primary care physician were to prescribe a medication that could form a fatal cocktail with whatever opioid a specialist were to prescribe, nobody would know until a patient was found dead. The miscommunication is not only between doctors, but also between doctors and patients. Dr. Adams, a pain specialist discussing opioid abuse at a U.S Senate hearing, stated, “You would not believe how many prescribers we talk to who had no clue that the patient they had been prescribing to died, and died because of the opioids they prescribed. There’s no feedback loop.”(Brady, 2016) If one looks at the regulations surrounding opioids, you’ll find loose regulations handed down from the U.S Food and Drug Administration that come from policy changes enacted in the 1990s.

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In West Virginia, dozens of medical nonprofit groups are currently pleading with hospital regulators to tighten national rules for prescribing painkillers after the allegations brought against Dr. Kostenko and company.(Axelrod, 2016) These groups and many others believe that doctors should be held accountable for their actions, and that they need to realize that there is risk with prescribing drugs that could potentially kill their patients. A medical journal published that patients with low back pain and chronic headaches with no physical cause, do not exhibit improvements in quality of life and are at high risk of developing dependence, or addiction from opioid use.(Ballantyne, 2015)

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Now hearings and cases are being presented on a daily basis in favor of stricter FDA rules and regulations, all in an effort to reverse the damage that over prescribing has done. Senators and witnesses are all in agreement that the opioid epidemic could be lessened by improving drug prescription guidelines, expanding funding for overdose-reversal drugs, and allowing Medicare to adopt practices to prevent patients from getting opioids from multiple prescribers.(Brady, 2016)Ultimately, a change needs to come from the health industry or else the epidemic will surpass all resources to aid those addicted to opioids, and other drugs.