The U.S. House of Representatives Washington, DC

 

 

The Opioid Crisis and Alternatives for Pain Management

 An Investigative Report

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Prepared
for:

 

The
United States House of Representatives

U.S.
House of Representatives

Washington,
DC 20515

 

 

Prepared
by:

 

Drug
Policy Alliance Representative

Joshua
Melendez

Knoxville,
Tennessee 37916

 

 

 

December
8th, 2017

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               i

 

Drug Policy Alliance                                                                                                                                     
344 Cumberland Ave                                                                                   
                                      Knoxville,
TN 27916

 

December 8, 2017

 

The United States House of
Representatives                                                                                
U.S. House of Representatives                                                                                                 Washington,
DC 20515

 

Dear Representatives:

I am a representative for Drug Policy
Alliance conducting a report on the Opioid crisis. The Drug Policy Alliance,
founded in 2000, believes drug policies should be based on science, compassion,
health, and human rights; we promote policies and attitudes that reduce the
harms of both drug use. Within this document is an investigative report
regarding the opioid crisis and possible alternatives for pain management. This
crisis has been an ongoing battle and over the years we have not been winning
this fight.

The goal of this report is to examine the
origins of the opioid crisis, the measures that have been taken and how these
have failed, and what can we do now to solve this issue. This document will
discuss how Alternative Pain Management treatments may be a viable solution for
the crisis. The efficacy of these alternative treatments will be explained with
case studies.

As representatives of the American people,
it should be our best interest to help cure our nation form this crisis. We
cannot continue to let this problem go unsolved. The Drug Policy Alliance
wishes to aid our legislators on how we can tackle this problem together. This
report can serve as a guide for you all in reforming opioid drug laws and
saving our people from overdose and addiction.

Thank you for taking the time to think
about how we can go about solving this problem. 
My colleagues and I hope you take our research and suggestions with an
open mind and that you all begin to see how you all can save Americans
suffering from opioid addiction.

 

Sincerely,

 

Joshua Melendez                                                                                                           
                      Drug Policy
Alliance                                                                                                                       
Public Relations Officer

 
Table
of Contents
Letter of
Transmittal
i
 
Executive Summary
ii
 
Introduction
1
 
Body/Findings:
 
  Origins of the Crisis
2
 
  Measures Taken
4
 
  Alternatives
and Their Efficacy……………………..………………………………………….. 6
 
Conclusions & Recommendations…..……………………………………………………………..
7
 
References…………………………………………………………………………………………..7
 
Works Consulted…………………………………………………..………………………………………8

 

 

 

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               ii

 

The Opioid Crisis and Alternatives for Pain Management

 

Executive Summary

 

There are many Americans suffering from the opioid
crisis and this issue has only gotten worse since it started. For many
Americans, this addiction is difficult to overcome.

 

The amount of people who suffer is staggering and
this led members of Drug Policy Alliance think –What led to all this? This is
the question that started our search for the solution. To find the solution,
you must first understand how the problem came to be. During our research, we
then took it a step further to find what had been done by the government to
solve the issue and has it been effective. Finally, we then asked what can we
start doing differently to fix the problem. 

 

This investigative report will guide through our
thought process and what we believe is the root of the problem and the nature
of the solution. By the end of this report the goal is for you all to
understand:

 

1.      What is the Cause of Opioid Crisis?

a.       Pharmaceutical Companies lobbying.

2.      What Had been Done in the Past?

a.       Pharmaceutical companies assisting in the regulation of opiates.

3.      What Can be Done Now?

a.        Revert laws and regulations and
seek alternatives for treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               1

 

 

Introduction:

 

 

Purpose

 

The purpose of this report is to investigate the cause of the
opioid crisis, the failed efforts to alleviate the issue, and what can possibly
be done to solve the problem. The report will also recommend alternative pain
management options to use in place of opiates. This report
will guide through our process of thinking and what we believe to be the root
of the problem and how we can go about solving it. By the end of this report
the goal is for you all to begin to take a course of action that can come to
solid results.

 

Background

 

According
to the Center for Drug Control, in 2016 more than 64,000 deaths resulted from
opioid overdose here in the United States. The number of deaths associated with
the opioid crisis is a growing concern and the Drug Policy Alliance would like
to find out why this is a problem and what we can do about it.

 

This
report was commissioned by the Director of Drug Policy Alliance, Markus
Trellis, on October 31, 2017.

 

Method of Investigation

 

Questioners were issued to public on August 15, 2017
by the Pew Research Center. They found that nearly half of adults in the United
States have a close friend or family member who’s been addicted to drugs.

 

Scope

 

This report will be considering how pharmaceutical
companies help kick the opioid crisis into motion, how they have helped
implemented counterproductive drug policies for the crisis, and what we can do
instead to solve this problem.

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               2

 

Origins of the Crisis:

 

During the 1960s and the 1970s many physicians were
trained to reserve opioids for the most serve forms of pain like cancer or
end-of-life care. This was the standard practice until the opioid prescribing
policies changed during the late 1990s when patient advocacy groups and pain
specialists, influenced and backed by pharmaceutical companies, began to claim
that doctors were undertreating common forms of pain that could supposedly benefit
chronic back and joint pain. Pharmaceutical companies and other financial
backers lobbied at state medical boards to pass a bill that would allow doctors
to more freely prescribe opiates.

 

They were successful in making many state
legislators make changes to the regulation of opiates; over 20 states saw these
new guidelines. Many physicians began to believe that opiates were safe for
their patients and the public also began to hold that opinion. With the
implementation of these new policies, pharmaceutical companies ultimately saw
an increase in profits from the sale and distribution of opiates. Large
pharmaceutical companies would create multimillion-dollar promotional campaigns
that were aimed directly at the medical practitioners that prescribed them.

 

One example would be the popularly prescribed drug
OxyContin. This drug was promoted to be less addictive and safer than other
prescribed opiates. This was a largely false claim as OxyContin is highly
addictive. In 2013 the National Survey on Drug Use and Health found that “people
aged 18-25 were most likely to report ever having used abused oxycodone (9.9%)
compared to 6% of people 26 and older.” That same year the NIDA found that US
pharmacies prescribed more than 53 million prescriptions of OxyContin.

 

 To put this
into perspective, this would mean one bottle for every six people in the US.
Over 65,000 people visited the emergency room due to OxyContin overdose or
adverse reactions in 2009. The very drug that was marketed as safe has been
proven to be dangerous; OxyContin is just one example. Despite this, it was the
combination of a more aggressive approach to pain management and marketing
efforts that led to the creation of the opioid crisis. Below is a graph
depicting the correlation between the sale of opiates and the number of deaths.

 

 

 

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               3

 

 

 

 

 

The problem behind the opioid crisis is not the
abusers, but the pharmaceutical companies that produce and sell these drugs. As
the years went on from the policy changes imposed by pharmaceutical companies
the government official and the public began to take notice and began to take
measures to solve the issue.

 

 

 

 

 

 

 

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               4

 

Measures Taken:

 

In March of 2016 the Center of Drug Control (CDC)
published “The Guideline for Prescribing Opioids for Chronic Pain”. The guide
was created to improve patient care and safety and preventing opioid overdose.
The new guidelines consisted of 12 recommendations for physicians prescribing
opiates. Below are three points that were key for doctors to follow:

 

First, non-opioid therapy is preferred for chronic
pain. (Aside from active cancer, palliative, or end-of-life care.) When
used, opioids should be added only when their expected benefits are likely
to outweigh their substantial risksSecond, use the lowest possible effective dose to
reduce the risks of opioid use disorder and overdose. The rule of thumb is
“start low and go slow.”Third, doctors should monitor all opioid-using patients
closely. This includes, for example, avoiding concurrent use of
conflicting drugs, reviewing data from prescription-drug monitoring
programs, and having a clear “off-ramp” plan to taper and discontinue
therapy.

This program was known as the “Start
Low Go Slow” and although it seeks to help alleviate the issue, it does very
little to stop it. These new guidelines did not seek to stop prescribing
opiates but to simply better manage the patients that use them. In 2016 the
National Safety Council conducted a national survey of medical practitioners
who see 70% of their time seeing patients for pain management. In the survey,
they found:

· 99% of doctors prescribe highly
addictive opioids for longer than is recommended by the CDC, which is three
days.

· 74% of doctors incorrectly believe
morphine and oxycodone are the most effective way to treat pain.

· 99% of doctors have seen a
pill-seeking patient or evidence of opioid abuse, but only 32% usually refer
the patient to treatment.

·
67% of doctors are, in part, basing their prescribing decisions on patient
expectations.

It can evidently be seen that these guidelines are
ineffective from the survey results and are doing little to help solve the
opioid crisis. This may be the fact that they are simply
“guidelines/recommendations” and this makes for weak policy. Below is a graph depicting
the number of deaths from opioids and it can be clearly seen that from 2016,
the creation of the guidelines, to 2017 there has been an increase in the
number of deaths.

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               5

 

 

 

 

Guidelines are not the solution despite the respectable
intentions. One speculation based on what happened in the past with
prescription policies is that it may be possible that pharmaceutical companies
still have their influence on politics. Any policy change regarding the sale of
opiates would decrease the profits made by these companies.  It is in their best interest that these drugs
remain on the market despite their high potential for abuse.

 

 

 

 

 

 

 

 

 

 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               6

 

 

Alternatives and Their Efficacy:

 

The Drug Policy Alliance believes that the solution is the
implementation of stronger policies that seek to end the opioid crisis entirely.
Policies such as these would pose a threat to pharmaceutical companies. As
stated earlier, the problem is the source of these drug and no matter what “guidelines”
are put in place the opioid crisis will always remain unsolved. The problem is
that doctors have no alternative treatments to use for pain management. In
fact, many doctors and patients are unaware of alternative methods for pain
management as mentioned in the precious section. There are many alternatives
that can be effective for managing pain in patients and this could serve as a
solution to the problem.

 

Congress should seek to pass a bill that will revert the
changes made to prescribing polices during the 1990s so that opioids are
prescribed less. Alternatives for pain management would then take the place of
what was the norm. These alternatives include:

 

·        
Acupuncture

o   In a study published in 2007 by the
University of Manchester, found that acupuncture was an effective treatment for
temporomandibular joint myofascial pain. The results demonstrated that real
acupuncture had a greater effect on the measure of pain than those of the
control group. Acupuncture could be one alternative physicians should consider
for pain management this case study is just one of many that show the efficacy
of this type of treatment.

 

·        
Cannabis

o   In
a study published in 2003 by McGill University Health Center, found that 78% of
participants reported moderate pain relief after using Cannabis. This study
shows that cannabis could be a viable alternative for pain management due to
its ability to alleviate chronic pain without the risk of addiction or
overdose.

 

·        
Chiropractic manipulation     

o  
In a study published in 1995 by the New England
Journal of Medicine found that 59% of patients saw an improvement in their back
pain within 8 days and 90% saw a full recovery within 16 days of treatment.
This treatment although aggressive, can be a viable solution for the management
of pain.                                                                              

Each of these methods have little to no side effects and have
no potential for harm for the patient. If doctor were to use these methods
instead of prescribing opioids we would see a dramatic decrease in death
resulting from overdoes because they are not being prescribed. 

 

 

The Opioid Crisis and Alternatives for
Pain Management                                                               7

 

Conclusion
and Recommendations:

 

This report explained how the opioid
crisis came to be, what has been done about it and how it has been ineffective,
and how we can solve the problem now by reverting policies and offering
alternatives for pain management. We also saw how pharmaceutical companies had
influence on policies in a way that could benefit them and their corporate
interests. In the future, we hope to see that the American Government begins to
help to put an end to “profit over people”. 
Large corporations should not have the power to exploit physicians and
patients in the medical system simply to increase their profits. We cannot
allow financial backers lobbying for polices that do not have in mind the
wellbeing of people here in America; only then will this crisis be solved.

 

 

References

 

 

Headquarters

 

131 West 33rd Street, 15th Floor

New York, NY 10001

212.613.8020 ph

212.613.8021 fx

[email protected]

 

 

State Offices

 

 

Washington, D.C.

1620 I Street NW, Suite 925  

Washington, DC 20006

202.683.2030 ph

202.216.0803 fx

[email protected]

 

New York (Policy)
330 7th Ave, 21st Floor
New York, NY 10001
212.613.8020 ph
212.613.8021 fx
[email protected]

 

The Opioid Crisis and Alternatives for
Pain Management                                                               8

Works
Consulted

Smith, P., Mosscrop, D., Davies, S.,
Sloan, P., & Al-Ani, Z. (2007). The efficacy of acupuncture in the
treatment of temporomandibular joint myofascial pain: A randomised controlled
trial. Journal of Dentistry, 35(3), 259-267.
doi:10.1016/j.jdent.2006.09.004

 

Carey, T. S., Garrett, J., Jackman,
A., Mclaughlin, C., Fryer, J., & Smucker, D. R. (1995). The Outcomes and
Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care
Practitioners, Chiropractors, and Orthopedic Surgeons. New England Journal
of Medicine, 333(14), 913-917. doi:10.1056/nejm199510053331406

 

Ware, M. A., Doyle, C. R., Woods,
R., Lynch, M. E., & Clark, A. J. (2003). Cannabis use for chronic
non-cancer pain: results of a prospective survey. Pain, 102(1),
211-216. doi:10.1016/s0304-3959(02)00400-1

 

National Safety Council. Prescriber
attitudes and behavior related to prescription opioid pain medication. March
13, 2016. Accessed at:
http://www.nsc.org/NewsDocuments/2016/Doctor-Survey-press-briefing-32416.pdf on
05.16.2016.

 

Johns Hopkins Bloomberg School of
Public Health. The Prescription Opioid Epidemic: An Evidence-Based Approach.
Nov. 2015. Accessed at: http://www.jhsph.edu/research/centers-and-institutes/center-for-drug-safety-and-effectiveness/opioid-epidemic-town-hall-2015/2015-prescription-opioid-epidemic-report.pdf
on 05.02.2016.

 

New England Journal of Medicine.
Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. 2016;
374:1501-1504 April 21, 2016DOI: 10.1056/NEJMp1515917. Accessed at:
http://www.nejm.org/doi/full/10.1056/NEJMp1515917?af=R=currentIssue on
05.03.2016.

 

Modern Healthcare. CDC opioid
prescribing guidelines unlikely to affect physicians’ practices. March 15,
2016. Accessed at:
http://www.modernhealthcare.com/article/20160315/NEWS/160319936 on 05.02.2016.

 

KevinMD. The opioid epidemic: It’s
time to place blame where it belongs. April 6, 2016.

Accessed at: http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html
on 05.02.2016.