The Gender Disparity of the Opioid Crisis

chronic pain pills womenA recent opinion piece in the Star Tribune shined a light on the problem different genders face in the opioid crisis, particularly the challenges faced by women.

One of the main talking points is that deaths from opioid overdoses have increased much faster for women than for men. Female deaths from opioid overdoses have increased 400 percent in recent years compared to 265 percent for men. Both of these numbers are very problematic, but it helps to show that the opioid crisis is affecting each gender differently.

When opioids affect women, it can oftentimes have a bigger trickle down affect than when it affects men. As the article states, in most American families the woman is the primary caregiver, and the woman’s well-being is often closely tied to the health and future of the children. Opioid abuse by the primary caregiver can often lead to problems down the road for the children, and it increases their likelihood of having their own battles with substance abuse. When opioids negatively affect women, it rarely impacts just one person.

Fixing The Problem

The article went on to suggest some ways to reduce opioid disparity and the larger problem of gender-based health disparities in the United States. Some of the proposed solutions include:

  • Addiction risk education for doctors and patients
  • More education has led to fewer opioid prescriptions and in some places, a downturn in overdose deaths
  • Better emergency room treatment
  • Education campaigns to change dosage standards for women
  • Increased doctor education in states where women disproportionately suffer from conditions like obesity, high blood pressure, diabetes, chronic pain and heart problems
  • Stop cutting insurance coverage for certain programs like Medicaid and Medicare

It’s clear that there’s no one-size-fits-all answer for fixing the opioid crisis and gender-based healthcare disparities throughout the country, but the first step is to help spread awareness that a problem exists. Then we need to put a plan of action in place and stop making the bottom line a higher priority than the health of the patient in our office.

Opioids certainly have a place to help patients when properly assigned and administered, but far too often they are being blindly prescribed and without safety measures in place if abuse begins. The Star Tribune article is a step in the right direction by calling attention to the problem, but now we need doctors, patients and our legislatures to follow through. For the sake of women and families across the country, I hope we can work towards a solution.

Minnesota Getting $16.6 Million To Fight Opioid Epidemic

opioids chronic pain minnesotaMinnesota is set to receive $16.6 million in federal grants that will be given to foundations and organizations committed to fighting the opioid epidemic.

More than 30 different agencies will receive grants from the federal fund, and the goal is to reach and help more than 110,000 Minnesotans who are seeking treatment for opioid dependency. Most of the money will go to existing programs to launch new efforts or expand current efforts in combating the opioid crisis.

“These grants are designed to build on what we are doing,” said Minnesota Human Services Commissioner Emily Piper.

The Opioid Problem In Minnesota

According to health data, there were nearly 2,500 opioid-related overdoses last year, and 376 of those overdoses were fatal. There were more than 3.5 million prescriptions written for opioid painkillers in Minnesota in 2016.

The federal grant will go to a number of specific places and programs, including:

  • More widespread availability of naloxone, a key substance in helping save people who have overdosed on painkillers.
  • Expanding medication-assisted treatment.
  • Increasing aid and resources on American Indian reservations.
  • Adding opioid-specific care providers throughout the state.
  • Establishing a program to help unborn and newborn babies of mothers with opioid dependencies.

There has also been a push for more regulation at the national level from Minnesota lawmakers. A presidential opioid crisis commission recommended that President Trump support two bills proposal by Minnesota Senator Amy Klobuchar. The first would require more monitoring of drug prescriptions and the second would attempt to reduce the number of opioids that are being illegally distributed through the US mail system.

The Landscape of Addiction in 2017

addiction opioidsOne of my favorite activities is reading. I read a wide variety of things, some of the most interesting things come from magazines that are not medical. Time magazine regularly has interesting stories of health.  Science, a bi-weekly publication, routinely has articles on a wide range of subjects that challenge the core of what one thought was fact. National Geographic regularly throws in medical stories. A couple years ago they had a great summary on marijuana, and recently now they had a great article on addiction. Medical journals are often a somewhat dry and boring read, but they do allow one to keep up-to-date with current research. Sometimes these other magazines have extremely valuable information as well.

The September 2017 National Geographic lead story is on The Science of Addiction. The problem is more than just opioids, it is a vast variety of problems from smoking to gambling and including all kinds of drugs. Addiction is a very complex process in the brain, and is definitely a disease and not a moral failing. Different types of addictions may affect a variety of brain regions. The processes involve disruptions in pathways responsible for learning, emotion, desire, regulation, and cognition among many neural events. It can change chemical, hormonal, and electrical paths in the brain. Addiction becomes abnormal learning in the brain with the reward being the addictive activity.

Addiction And Our Brains

All addiction has its roots in the primitive regions of the brain. They have to do with our need to survive, and they all involve our senses like sight, smell and taste. Critical in addiction is the neurotransmitter dopamine and that stimulates brain motivation. Those lacking dopamine often are depressed. Further, Parkinson’s disease has a lack of dopamine, and when given to some patients, it causes problems with an addiction like gambling. When something is addictive, it stimulates the dopamine pathways in the brain and is a very positive reward. The dopamine reward is so strong in the brain, people lose the control of impulses and the ability to inhibit behavior even if it is self-destructive.  

Since there are many things that are now considered true addictions, it is likely there are many different strategies to treat them. For drugs, often there are medications that can block the pleasure from the drug and prevent withdrawals. For alcohol, there are drugs that make drinking nauseating. There are also numerous counseling strategies and psychological-type interventions to deal with the behavioral components of addiction. There are also some new novel strategies including electrical and magnetic stimulation of specific areas of the brain to treat addiction.

The problem of drug addiction or any type of addictive behavior is caused by abnormal function and rewards in the brain. Pain and the problems associated with the medications taken can cause addiction, but this isn’t always the case. Taking opioid medications does lead to dependence and tolerance of the drugs that cause them to lose effectiveness. Opioids can also change a person’s sensitivity to pain and make a person perceive pain sensations more intensively. Therefore, in general, opioid medications have many downsides.

Lastly, opioids can be addictive and cause typical addiction issues in pain patients, but it is in only in a small percentage, somewhere between 5-20%. In most chronic pain patients, addiction and problems with opioids are generally not a typical problem. Treatment in pain patients is the same as with any other person who has opioid problems, and is often best handled by a pain care specialist.  If you are a pain patient on opioids, and taking your medication has become the focus of your life, then it is probably time for one to be treated for addiction and be off of these medications.

Let’s Focus On The Pain Epidemic, Not The Opioid Epidemic

pain opioid epidemicA recent article in the Star-Tribune noted that every three weeks, the death toll from opioid overdoses matches the death toll from the attacks on the World Trade Center on September 11, 2001. Not only is this a concerning number, but trends show that the death toll from opioid overdoses is continuing to skyrocket. The government and even President Trump have stated that the opioid epidemic is a problem that needs to be solved, but are they looking at the problem in the right way?

The opioid crisis is a huge issue, but it’s only a symptom of a larger problem, which is the pain epidemic in America. More people are turning to opioids in the United States because more of them are fighting a losing battle against pain. We need to be finding solutions to the pain problem, because the opioid crisis is a symptom of the problem of pain.

Stopping Pain

Think of it this way. Let’s say you’re in your house and you see smoke. You run to the kitchen and notice a fire behind the stove. You quickly fill up some water from the sink and douse the flames with water, stopping the fire in its tracks. It’s great that you stopped the fire, but you wouldn’t just go back into your living room without investigating what caused the fire to start in the first place. If you don’t fix the faulty wiring that caused the fire, you’re prone to another fire in the future.

In the above instance, throwing water on the fire is like trying to treat the opioid epidemic. It is a problem that needs to be addressed, but unless we also focus on the root problem, which is pain (or faulty wiring in this case), then the problem is only going to continue to be cyclical. Eliminating opioids may reduce the number of overdose deaths, but it will also hurt patients who use them responsibly to manage their pain, and severely cutting back on opioids will do NOTHING to solve the pain problem.

What We Need To Do

Enough about what’s wrong with the current system – here’s a definitive list of what we as a nation need to do in order to fix the opioid crisis and the pain problem in America.

  • We need to educate both patients and doctors about how opioids work in conjunction with a multi-faceted approach to pain management.
  • Opioids can play a role in pain care, but they can’t be the only treatment option. They can help manage pain, but they are not a long term solution to treat pain. Anybody who is only taking pain medications for their condition is at a high risk for dependency and has a low chance of ever recovering from their pain.
  • We need to open up insurance coverage to other non-traditional methods of pain management. Let’s get creative with pain management, because what works for some will not work for others.
  • We have to pound home the message that there is no magic pill for pain, but tangible solutions are within your reach.
  • Doctors need to do a better job of pushing people towards tangible solutions instead of quick fixes. Things like physical therapy, aqua therapy, cognitive behavioral therapy, yoga, etc. over writing a quick prescription.
  • We need to invest research funding into pain treatments, whether it’s medical marijuana or new diagnostic tools, we need to spend money on solving the problem of pain. Invest in pain solutions like we’re investing in treating cancer or diabetes.

If we can check off all the items on this list, I’m confident we can find new ways to treat pain, and in turn combat the opioid crisis in America.

Doctor Killed For Not Prescribing Pain Pills To Patient

pills doctor killedLast week one of my colleagues in the Pain Medicine community was shot and killed for not writing an opioid prescription to a patient. I was sent an email from a manager who came across the information in passing, and I was shocked at the incident.

The worst part of this incident was that the victim and colleague was once a medical student and then a medical resident with me while I was in training. I have not kept in touch with him but he was an excellent doctor and a caring individual. Unfortunately, that did not matter to the person who killed him. The only thing they understood was he did not feel it was indicated to prescribe opioids, which in retrospect was clearly the right choice.

Addictions and Opioid Dependence

Pain management and treating pain has always been more than prescribing medications like opioids. Anyone who has read this blog knows my field is all about how complex treating pain has become. If you as a patient believe that the only thing you can do for your pain is taking opioids, you likely have an issue with addiction that is far beyond just managing pain.

Addiction is a psychological problem and one does irrational things to obtain whatever substance you want for the dopamine support. The things one would do are beyond societal norms and are often illegal. The problem is not only about pain; it is about how to manage the addiction. There are countless ways to manage pain and unfortunately there often is not a cure. Pain management clinics are faced with the problems of opioid use every day and one of the most important jobs we have is to find other options beyond these medications to help patients. There is a shortage of professionals who have the training and ability to work in this challenging area, and it is tragic that someone has lost their life doing the right thing.

Alternatives To Opioids

Having pain is a common occurrence in this world. Worldwide about 30 percent of the population has problems with pain on a regular basis. The use of opioids to solve pain problems has become an American solution. The United States uses 95 percent of the narcotics produced in the world, yet we are only 5 percent of the world’s population. If your doctor is saying no to opioids, there usually is a good reason, and working with a specialist to find a better solution is indicated.  Most people, once they develop significant neck or back issues, will not be pain free, but one needs to make some life changes to control the symptoms. Pain is a tough medical issue and the United States does have an opioid epidemic.  

If it is upsetting that there are not better treatments for pain, become vocal about this problem. Start with your insurance company and with your legislators and make it known you want money to be spent on paying for more treatments for pain. Money is being spent on addiction but one of the more important issues is spending money on treating the pain problem before it becomes an addiction. Pain is a grueling and depressing part of life. There are hundreds of pain professionals trying to make life better for those suffering with pain, please do not let your anger out on them.