Dr. David K. Keith

In The News

Opioid Epidemic

America is in the midst of an opioid epidemic. As your Doctor, I wanted to address this very serious issue. The abuse of opioids such as prescription pain relievers, morphine, and heroin have had far reaching effects on the health, social, and economic welfare of our society. Due to increased availability of prescription opioids, overdose deaths resulting from their misuse has more than tripled in the past 20 years.

Millions of people suffer from acute and chronic pain and seek help from primary care offices, emergency rooms and pain management specialists. Chronic pain differs from acute pain in that it generally persists for 3 continuous months. Chronic pain is complex, multifactorial, and carries a significant health burden. As such, physicians are beginning to re-conceptualize approaches to treating this chronic condition in light of the evolving understanding of the dangers related to continuous use of opioids. However, some modalities like massage therapy, physical therapy, myofascial release, acupuncture and cognitive behavioral therapy are not always reimbursed by public and private insurers, leaving doctors with challenging decisions to make in their patient treatment plans.

It is a delicate balance for physicians to weigh the benefits versus the risks when designing a treatment plan involving any kind of pharmacologic therapy. Opioids work by mitigating pain, often producing a sense of well-being and pleasure in certain parts of the brain. Some individuals seek to intensify this effect by taking it for non-medical purposes, which can lead to addiction. According to National Institutes Health data from 2012, the incidence of heroin use was 19 times higher among those who reported non-medical use of opioid pain relievers.

While opioids have garnered much of the attention, there is a growing awareness of benzodiazepine misuse and abuse (i.e. Ativan, Valium, and Xanax). Like opioids, when these drugs are misused or abused, dangerous and detrimental side effects may occur, including respiratory failure and even death. When opiates are combined with benzodiazepines, alcohol or other nervous system depressants, there is a higher risk of overdose.

We have to stop this epidemic. There is plenty of blame to go around. The general public is seeing an all hands-on-deck approach from policy-makers to doctors to patients. It starts with education. There are local, state and federal agencies setting new policies on the current abuse of prescription medication, while also advancing addiction awareness. Patient education and public awareness of the risks of overdose, drug take-back programs, and safe storage and disposal are also important precautions. Finally, those individuals with a substance use disorder need to receive evidence-based treatment in a less stigmatized approach.

As your family doctor, I take the pledge along with many of my colleagues to help end the opioid epidemic. I will continue to educate myself to diagnose and treat pain effectively and safely with an evidence-based approach. It is my goal to delineate the source of your pain while using non-pharmacologic measures and non-opioid pain relievers where appropriate.

Parks T. Pain Expert: Judge the opioid treatment, not the patient. AMA Wire with Daniel P. Alford M.D. as contributor. June 28, 2016

Volkow, N. America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. Senate Caucus on International Narcotics Control., May 14. 2014.