Chronic Pain & the Rx Opioid Epidemic
Prevalence of Chronic Pain
Chronic pain affects up to one-third of the U.S. population, an estimated 100 million people. And, according to the National Institutes of Health, its prevalence is growing and will likely continue to.
By definition, chronic pain persists for at least three months, and often for years or even a lifetime. It has many causes, and is often linked to other health conditions. Chronic pain can compromise a person’s ability to work, to play, to parent, to sleep, and to enjoy life. It is often intractable.
The economic cost to society is also high. According to the Institute of Medicine, pain costs society at least $560-$635 billion annually.
Prescription opioid epidemic
As awareness of the extent of chronic pain grew in the 1990s, the U.S. health system increasingly turned to opioid pain medications as a treatment of choice, and their use quadrupled over the past two decades.
But prescription opioids are based on the same chemical compounds that make heroin an addictive and dangerous drug. Although they can sometimes relieve chronic pain, they can also lead to misuse, abuse, overdose, and death. As the rate of opioid prescribing skyrocketed, so did the rate of opioid poisoning deaths.
In total, more than 100,000 people have died from prescription opioid overdoses since the late 1990s. And for every death, more than 30 others end up in the ER. Poor and underserved populations receive different treatment when compared to other populations. Improving treatment of patients with chronic pain can improve quality of life and health equity.
Unintended consequences can stem from simple mistakes in prescribing, or incomplete information. Nearly 60% of patients using long-term opioid therapy from 2009-2013 were taking dangerous and potentially fatal combinations of drugs, usually benzodiazepines and opioids.
Healthcare providers making a difference
Three years ago, in reaction to the alarming death rate of more than 16,000 prescription opioid overdoses per year, the US Food & Drug Administration (FDA) issued a Risk Evaluation and Mitigation Strategy (REMS) for long-acting, extended-release prescription opioid medications. The “FDA REMS” requires prescription opioid manufacturers to mitigate risks posed by their products, including through funding independent education programs for healthcare providers.
UW Medicine’s COPE-REMS course was one of the first nationally to offer a fully REMS-compliant course, and is supported by an independent education grant from the REMS Program Companies.
In addition to provider education, there have been changes in policies, drug formulations, laws, and education that are slowly making a difference. Today, rates of abuse and death are finally starting to plateau or decline but there is a long way to go.
Through continuing medical education that provides the latest information, tools and communication techniques for treating patients with chronic pain, health care providers can deliver better care to their chronic pain patients, improve lives, save time and medical costs, and help drive down the number of prescription-opioid related overdoses and deaths.