Opioid overdose: Don’t blame the patient
As someone who knows people — including loved ones — who are dependent on opioids, I agreed for a long time with the 67% of Americans blaming drug users for their opioid-use disorder. That is, until I met Billy.
Billy (not his real name, to protect privacy) was an intelligent student who was close to his sister and mother. At age 16, after ACL surgery, he was prescribed opioids for pain. Billy’s tolerance for the drug grew quickly, and he sought out doctors for more opioids. His path to opioid-use disorder had begun.
Frightened, Billy went to his primary care physician, Dr. P. His story came out: how he started taking too many pills, how it affected his family. He told Dr. P. he had heard of a drug called buprenorphine that could treat his opioid-use disorder.
Dr. P said she could not prescribe it because she didn’t have the right kind of license. (She later admitted the reason she didn’t have a waiver to prescribe buprenorphine was that she doesn’t have enough time to complete the required online training.)
“I do not want to deal with patients who need it. These patients manipulate drug screenings, are irritable and cause problems in the office,” she said later.
A year later, I happened to see Billy’s real name in a news article. Teen brought in by ambulance… unable to resuscitate… death due to overdose on opioids.
Who is to blame? Billy, for taking more than the recommended number of pills? His family, for not being more supportive when Billy asked for help? Dr. P., for not being able to prescribe him medication that could have helped him? Maybe it’s the insurance company for charging too much for that medication, or the pharmaceutical companies that made the opioids, or the government for not offering enough access to treatment?
According to the CDC, 47,000 Americans died of opioid overdoses in 2017. The agency calls it an “epidemic” and a “public health crisis.”
Opioid use and misuse have also increased in older adults, according to the National Surveys on Drug Use and Health.
Yet we have a broken system when it comes to opioid-use disorder (OUD). I believe Billy’s death was preventable. He had severe OUD and sought medical help. I can’t think of another therapeutic area where a patient with a disease is not started on treatment immediately.
According to the American Society of Addiction Medicine (ASAM) we can do two things to help:
— Provide support to the patient.
— Detect opioid-use disorder early by asking the following questions:
Have they taken opioids for longer or in larger amounts than intended?
Do they crave or have a strong drive to use opioids?
Do they spend a lot of time and effort to get and use opioids?
Have they missed work, given up spending time with friends and family or doing enjoyable activities to use opioids?
Do they give up important social or work-related activities to get and use opioids?
Have they been in situations that are hazardous to their emotional health or physical safety to get opioids?
Are opioids having a negative effect on their life? If so, are they still using?
Do they want to cut down or stop using opioids but can’t?
To effectively combat the opioid crisis, we need to acknowledge that opioid-use disorder is a disease, not a lifestyle choice. If each of us educates ourselves on the science, perhaps we can have a more impactful role in combating the opioid epidemic.
Jaymin Patel is a member of the Class of 2020 at VCU School of Pharmacy. He earned his undergraduate degree in biochemistry from Virginia Tech.