Vital Times 2017 - 64

The Opioid Epidemic and
Hospital Standards:
Get Ready for A Culture Change
By	Sunny	Jha,	MD,	Andrui	Nazarian	MD,	and	Shalini	Shah,	MD

T

he opioid epidemic continues to dominate much of
our national headlines. The statistics are alarming and
do not appear to be improving. In fact, an estimated 90
Americans die each day due to overdosing on opioids. The
misuse of both illicit and legal powerful narcotic drugs
has placed an indelible mark on our society. A countless
number of high profile deaths and disturbing videos
displaying unconscious parents with heroin syringes
in their arms while their children sit next to them have
demonstrated that this epidemic has no boundaries.
While the emotional impact may be immeasurable, the
CDC estimates that prescription opioid misuse costs
the United States nearly 78.5 billion dollars a year in lost
productivity and excess health care costs.
How did we arrive at such a quandary? No single factor
is responsible for starting this epidemic but many have
contributed. In the 1990's, misleading advertising by
pharmaceutical companies touted powerful narcotic
medications as safe, non-addictive and instrumental to
improving the quality of life of our patients. Prescriptions
increased and patients unwittingly grew addicted and
demanded these medications in ever growing numbers.
Concurrently, hospital accreditation organizations began
to essentially force practitioners to treat pain as the "fifth
vital sign" penalizing institutions and individuals who did
not take steps to reduce pain scores. Due to the increased
focus on pain, patients seemed to expect that having any
pain was abnormal and they began to demand and be

64 		|	 	 CSA	Vital	Times

provided treatment options. Opioids were the cheap,
easy and readily available solution which led to physician
over prescription, increased reliance on narcotics and
insufficient patient education on the risks and benefits of
this treatment modality.
Alternatives to opioids were often, long acting, labor
intensive and less likely to be covered by insurance.
Further, state medical boards mandated physicians
receive extra training in prescribing opioids more or
less endorsing opioid use as safe and effective treatment
modalities. Continued changes in societal expectations
on pain, insurance coverage, governmental policies and
numerous psychosocial factors have created a perfect
storm of circumstances that has led to one of the most
important health and societal challenges facing our
nation.
Today, patients with pain are increasingly facing a
negative societal stigma, increased judicial and health
regulation and decreased access and coverage for their
treatment. Patients facing the possibility of acute pain
related to surgical procedures often fear taking narcotics
and are demanding interventional procedures or
avoiding surgery all together. Practitioners are facing
onerous guidelines, decreased insurance coverage and
reimbursement and increased governmental and judicial
scrutiny. In total, these factors are further exacerbating
this epidemic by denying access, preventing treatment
and demonizing addiction.



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