Opioid deaths in Ohio, hell in the heartland

We are working hard to bend the curve of the opioid crisis here in Ohio. The cause of the crisis is complex and so is the remedy. Statistics examining the last several months have not yet been released, but the trend over the past several years is very troubling. When I first learned that Ohio was the epicenter of opioidmania, I was quite shocked, as I wrongly thought that this plague would spare the heartland. In contrast, it seems the heartland is ground zero. While I have no specific expertise in addiction medicine or sociology, here are my speculations on some of the contributors to the current crisis:
• aggressive marketing by pharmaceutical companies,
• deceptive marketing by pharmaceutical companies claiming non-addictive potential of their products,
• economic decline and hopelessness,
• increasing expectation by the public of a pain free existence,
• physicians prescribing opioids, rather than non-addictive alternatives, in response to a new prescribing culture for these agents,
• physicians writing opioid prescriptions containing more pills than necessary, and
• increasing availability of affordable, illicit opioids.

Ohio overdose deaths were 3,613 in 2016 and 5,232 for the 12 months prior to June 2017.

A popular bromide is to accuse the medical profession of spawning the crisis. While my profession clearly bears responsibility here, I think the causes are multifactorial. The reason it is so important to have a clear understanding of all the causes is that this is essential to successfully formulate a strategy to combat the epidemic.

It is a much easier task to prevent addiction than it is to treat it. While I support treatment efforts, experts have told me that the probability that an opioid addict can conquer the addiction is rather dismal. We all have heard vignettes of addicts who are revived multiple times by paramedics with naloxone, who immediately afterwards return to their addiction. If fact, some individuals have raised the question if there should be a limit on the number of times that an individual should be revived. I am not supporting this effort, but merely reporting on it here. However, city budgets have limited resources. How might a city's residents respond if someone died of a heart attack because the paramedics were treating an overdose victim for the fifth time?

This is going to be tough work, but I think it's a battle we must wage. Moreover, I truly believe that real progress is possible and is ahead. If we are all pushing in the same direction, then we can start to bend the curve.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.