Sohn: We're taking shortest of baby steps with opioids

FILE - This 2013 file photo shows OxyContin pills arranged for a photo at a Vermont pharmacy. (AP Photo/Toby Talbot, File)
FILE - This 2013 file photo shows OxyContin pills arranged for a photo at a Vermont pharmacy. (AP Photo/Toby Talbot, File)

Finally, doctors and dentists are looking seriously at their own roles in creating America's opioid epidemic.

One of Tuesday's front page stories in the Chattanooga Times Free Press noted that the American Dental Association has at last put teeth into the push to curb opioid prescriptions. A new ADA policy "essentially says eliminate opioids from your arsenal if at all possible."

The message came from Dr. Joseph Crowley, president of the ADA, a group that represents about 161,000 dentists. The policy is a step up from a previous one made in 2016 calling for dentists to consider nonsteroidal, anti-inflammation drugs as a first-line treatment for pain, according to The Associated Press.

photo Map Courtesey of the National Opinion Research Center at the University of Chicago and the Appalachian Regional Commission This screen capture shows a new interactive map, which aims to illustrate the scale of the opioid epidemic in Appalachia.

Dentists write fewer than 7 percent of U.S. opioid prescriptions, but new research shows that practice has increased in recent years, despite five Journal of the American Dental Association studies that show ibuprofen and acetaminophen work just as well for most dental pain and are less risky than addictive opioids.

A more frightening statistic, also noted previously in JADA, is that dentists are the leading prescribers of opioids for U.S. teens and - astonishingly - the largest increase in dental prescriptions from 2010 to 2015 occurred in 11- to 18-year-olds, an age when the growing brain, which doesn't mature until 25, is particularly susceptible to being taken over by opioids - even if the dosage seems too small to produce addiction. For that age group, the prescribing rate climbed from almost 100 to 165 per 1,000 patients. Among all ages, the rate increased from 131 to 147 per 1,000.

Last summer, Dr. Andrew Kolodny, a psychiatrist and addiction specialist, told The New York Times that 75 percent of opioid abusers started by taking a prescription, and 80 percent of heroin users started with prescription opioids.

Illegal pill-mill doctors may keep addicts going, but Kolodny argues that it's the legitimate doctors who get them started. "If we want to begin to reduce the number of new cases that occur each year, we've got to prescribe more cautiously," he told the Times.

This couldn't be truer for all ages, but it is especially important for young people. Kids who are prescribed any opioids in elementary school have a one-third chance of "lifetime illicit use," and one recent study of patients who had never taken opioids found that of those prescribed just a 12-day supply, one in four were still taking opioids a year later. That's patients of all ages, but it's likely higher with teens and young adults, the Times noted.

Doctors don't have a new policy - yet - but Science Daily on Tuesday reported a new study showing that emergency department physicians, lacking "self-awareness" and underestimating how often they prescribed opioids, decreased their prescriptions after they saw their actual data.

Just a month ago in February, America saw another hopeful sign. Purdue Pharma, the company behind prescription painkiller OxyContin, said it would stop marketing opioid drugs to health providers. The change meets a key demand of lawsuits that accuse the company of helping trigger the current drug abuse crisis by exaggerating the drug's safety and downplaying the risks of addiction. To market the drug, sales reps leaned heavily on one sentence on the OxyContin label: "Delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug."

Purdue's recent decision to back away from marketing the drug to providers marks a major change for the company that once aggressively pushed its sales staff to market OxyContin: "Dedicate 70% of your time selling Oxycontin!!!!!!!!!!!" reads a sales strategy memo dated Feb. 27, 2000. "We are selling Oxycontin 70% of the time!!!!!" reads another. "Remember to sell Oxycontin 70% of the time," reads a less enthusiastic email dated March 1, 2000. The documents were obtained by Marketplace.org, a radio and podcast program produced and distributed by American Public Media, in association with the University of Southern California.

The sales push worked: OxyContin became one of the most prescribed narcotics in the country, and Purdue has made over $35 billion in sales from OxyContin since 1996.

The medication also became one of the most abused pharmaceutical drugs in U.S. history. And did we mention that there were more opioid prescriptions than people in Tennessee in 2015, and that more people die of opioid overdoses in our state than in vehicle accidents, homicides or suicides?

A few days ago, Congress passed a new spending deal that commits a paltry $3.3 billion to address the drug and mental health crisis in fiscal year 2018 and another $3 billion in fiscal 2019. Previously, our nation had committed about $1 billion to combat the opioid epidemic through the 21st Century Cures Act.

But the devil is in the details. By comparison, we budget $32 billion a year to the HIV/AIDS crisis, which at its peak in 1995 caused fewer deaths in the U.S. than current yearly drug overdoses. What's more, investing much of the $6 billion in interventions like greater criminalization will be far less effective than on-demand drug treatment to save and turnaround lives.

So, kudos to dentists and to doctors. Kudos also to Purdue - despite the company's far-too-slow response.

Now if we could just get Congress on board - really on board.

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