Background on the Utah Epidemic

Over 100 million adults in the United States are faced with chronic pain. This pain may be due to surgeries, injury or chronic diseases, such as cancer. Each year an estimated $635 billion dollars are attributed to loss of productivity and medical expenses for those suffering from chronic pain (1). These people need and deserve solutions to reduce pain and help them to continue to live productive lives.

Those facing chronic pain want to be treated and want to have quick relief. When doctors are presented with patients reporting pain, 20% of the time they prescribe opioids (2). Opioids are effective for treating pain in the short-term but long-term use can have serious negative effects. Opioids are extremely addictive and overdose related deaths from prescription drugs have surpassed the rates of overdose deaths for heroin and cocaine combined1. The CDC reported that in 2013 there were 1.9 million people in the U.S. abusing or dependent on opioids2. There are many alternatives to treating pain besides the use of opioids. Those alternatives include Ibuprofen, Tylenol, massage therapy, physical therapy, exercise, cognitive behavioral therapy, medication for depression or seizures, interventional therapies and many others (3). However, these alternative methods are not employed frequently enough2. Opioid abuse is a national problem but is also of great concern in Utah, as in 2014 Utah had the 4^th highest drug overdose rate in the United States (4). Data shows that each week 6 people in Utah die from an opioid overdose.

More than half of patient visits are the result of pain. In the United States 60 million patients a year visit the doctor due to chronic pain(5). Physicians at clinics and hospitals want to satisfy those patients and ultimately patients will be satisfied if their pain is treated. One of the factors that hospitals and doctors are ranked on is how well they treat pain. This incentivizes doctors to prescribe pain pills to achieve a higher ranking, and subsequently, higher pay. Ultimately doctors are benefitting from patients who are prescribed pills for pain management, however, if changes were made, doctors would have more time to other patients. Many doctors have reported that prescribing pain pills for pain management is discouraging and burdensome.

The prescription drug companies benefit from the large number of opioids being used. The more sales that are made the more money these companies make. This may make pharmaceutical companies resistant to proposed policy changes. If prescription drug companies began losing money they would likely spend time formulating alternative treatments for pain. A new drug formulation that is less addictive could be very beneficial for society.  

The problem of prescription drug use is a problem that is perpetuated by both individuals and physicians. Individuals can help by asking their doctor what might be possible alternatives to taking opioids and by throwing away old prescriptions of pain pills. It is illegal to share prescription drugs. Individual adherence to this law could reduce opioid abuse. Individuals should make sure that they use pain pills the way that the pharmacist has directed, especially regarding the prescribed amount. When an individual is taking pain pills, a close family member or friend can help by monitoring the number of pills in the bottle and keeping track of any missing pills3. Finally, in Utah it is legal to save naloxone, a drug that can temporarily counteract opioid overdose.

In addition to individual changes, there should be changes made to the way that physicians treat chronic pain. This may best be accomplished through changes in policy. There are current bills pending to require doctors to be trained on how to treat overdose situations(6), to require doctors to use a database before prescribing pain killers(7) and a bill requiring insurance companies to cover alternative treatment methods for chronic pain(8). In addition to these bills, it could be beneficial to pass bills limiting the number of pills allowed to be prescribed after minor surgeries, limiting the number of doctors authorized to prescribe heavy pain killers and requiring doctors to explain the risks of taking opioids to their patients and encouraging them to get naloxone with their opioid prescription. In other states, before prescribing patients are required to be screened for depression and anxiety and doctors are required to perform a comprehensive physical examination(9). Examining and implementing policies from other states may be beneficial to decrease rates of opioid abuse.

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1. Daubresse, M., Chang, H. Y., Yu, Y., Viswanathan, S., Shah, N. D., Stafford, R. S., ... & Alexander, G. C. (2013). Ambulatory diagnosis and treatment of non-malignant pain in the United States, 2000–2010. Medical care, 51(10).

2. Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama, 315(15), 1624-1645.

3. What are Opioids? (n.d.). Retrieved February 01, 2017, from http://www.opidemic.org/what-are-opioids/

4. Utah State Health Department. (2016, April 25). Prescription Opioid Deaths. Retrieved February 01, 2017, from http://health.utah.gov/vipp/pdf/RxDrugs/PDODeaths2015.pdf

5. Khoadee, M., & Deffenbacher, B. (2016, December). A look at the burden of opioid management in primary care. MDEdge, in process.

6. Utah Gov. (n.d.). Utah State Legislature. Retrieved February 03, 2017, from http://le.utah.gov/~2016/bills/static/ hb0238.html

7. Utah Gov. (n.d.). Utah State Legislature. Retrieved February 03, 2017, from http://le.utah.gov/~2016/bills/static /HB0375.html

8. Utah Gov. (n.d.). Utah State Legislature. Retrieved February 03, 2017, from http://le.utah.gov/~2017/bills/static/ HB0090.html

9. Utah State Government. (n.d.). Common Elements in Guidelines for Prescribing Opioids for Chronic Pain . Retrieved February 04, 2017, from http://le.utah.gov/interim/2016/pdf/00002111.pdf