By Natalie Salinas 
It is important for social workers to get informed about the opiate epidemic in the USA and important that the information they provide to both clients and the public/media include both the micro and also the macro causes and solutions.
In reading the various articles on the opiate epidemic in California News for July 2016, I thought a few things were left out that are worth mentioning. I also thought a few things were left unclear and that could be clarified.
First, I thought there was a big focus on individual factors for the current epidemic and not enough said about the macro issues that led to the problem. Besides drug representatives promoting the opioid drugs as non-addictive and safe to use for chronic pain, it should be mentioned that the drug companies spent time and money to get others such as the FDA and the Joint Commission to agree with their agenda.
The concept of the “5th vital sign” in the USA became a Joint Commission standard in 2001 after being presented with misinformation by those that manufacture these narcotics. In 2007, Purdue Pharma and three of its top executives pleaded guilty to criminal charges that they had misled the FDA, Clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients as a safe alternative to short-acting narcotics.
When prevention is mentioned it tends to focus on doctors’ over prescribing and some education of the public; however, I recommend that social workers also push to eliminate the teaching of this supposed “5th vital sign” and requirements that physician and nurses use it. Since 2001 there has been a requirement in most institutions to have doctors include the “5th vital sign” in their assessments and to prescribe medications to address this pain. As the articles in California News mention, “The age-adjusted rate for deaths involving opioid analgesics nearly quadrupled from 200 to 2014.”
Next, while I appreciate that the problem of over prescription is going down, I think it is worth mentioning that it has not always been this way. In a 2005 national survey on drug use and health it was found that the primary sources of opioid pain relievers used non-medically where coming from over prescription (SAMHSA, September 2006). It was not until this year that I started to hear of doctors finally being held accountable for the gross over prescription that contributed to this epidemic. Opioid abuse has tripled since 2000 and overdose deaths now total 130 every day.
In 2009 SAMHSA reported that the prevalence of heroin was declining while rates of non-medical use of opioids were increasing. One of the articles makes it seem that deaths are mostly from heroin overdoses, while the other article correctly states, “In 2014, nearly 65 percent of all deaths from opioid analgesics involved natural and semisynthetic opioid analgesics, such as hydrocodone, morphine, and oxycodone.”
Lastly, and probably most importantly, one of the articles says, “…there are two camps…the chronic-disease view” that they describe is the “camp” that involves medication assisted treatment AND the other “camp” that involves 12-step programming that says, “if you’re not all clean you’re not recovering.” This latter statement is a myth of 12-step programs. Neither Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) literature nor its founding members spoke or wrote against using medications. Even today, AA/NA does not endorse encouraging AA/NA participants to not use prescribed medications or to discontinue taking prescribed medications for the treatment of addiction. In fact AA Chapter 9 of The Big Book states, “God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies.” In addition, AA/NA also belong to the “camp” that says addiction is a chronic disease.
One big elephant in the room is that while Big Pharma created the epidemic they now also stand to profit from the treatment of the problem. Increased access to naloxone (used to save people from an overdose) is among the measures included in federal legislation that Congress passed in response to the opioid deaths. As the demand for naloxone goes up the drug’s price has soared. One manufacturer increased the wholesale price of its auto-injector to $4,500 this year. This drug was less than $700 in 2014.
See the articles mentioned above for more information. Also worth reading are the following sources:
www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic.
Los Angeles Times, July 17, 2016.
