The opportunity to serve the Anderson community as an independent neighborhood pharmacist humbles me daily. Our access to a wide variety of medicines is the envy of most of the world, and it helps us lead happy and productive lives.
But, some of our loved ones succumb to a disease triggered by the very medicines that should help them. The disease is opioid addiction.
Opioid addiction usually results from pain management efforts following an injury or surgery, because healthcare providers often automatically resort to high potency drugs that promise immediate relief. Those drugs frequently cause addiction.
The default to opioid prescription stems from, according to many physicians, the priority of "patient satisfaction". Medicare, in particular, uses "patient satisfaction" in their calculus for reimbursement. One doctor put it this way: pain equals dissatisfaction, and dissatisfaction equals lower reimbursement, and lower reimbursement usually equals termination.
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A study in the Annals of Internal Medicine reports that over 92 million non-institutionalized adults used prescription opioids in 2015. Nearly two-thirds of those people reported that pain management triggered their use, and more than 13 million suffered subsequent misuse or abuse. The cause and effect are obvious.
Opioid addiction devastates patients and their families, and it affects the whole community. A recent study in ScienceDaily estimated that prescription opioid overdose, abuse and dependence cost America approximately $78.5 billion in 2016 in health care costs, incarceration and lost productivity. We all pay a price for this growing epidemic.
I have talked to other healthcare professionals from emergency room doctors to fellow pharmacists to drug wholesalers. We all agree on one thing: Americans are overmedicated, particularly on opioids, and that must change.
I see this problem far too often in my pharmacy. The healthcare industry must lead the way in defeating opioid addiction, and it starts with different strategies on the front end.
St. Joseph’s Regional Medical Center in Paterson, NJ began in January 2016 dispensing opioids for pain only as an absolute last resort. Emergency physicians, instead, first implement trigger injections, nitrous oxide and other therapies--and the non-opioid success rate runs close to 75%. The chair of emergency medicine there admitted that "this has been a major culture change".
We must pursue the same culture change in South Carolina, and it is beginning in some places.
One Upstate emergency room director already encourages his doctors to employ their medical training and good judgment when treating pain and not worry about patient complaints or reimbursement consequences.
Greenville Hospital System is gathering doctors from a variety of fields to implement alternative strategies that effectively treat pain.
These are good examples for others to follow.
We also must address this crisis on the back end. We must fully support law enforcement as they combat the criminal activity that often accompanies opioid abuse and presents a terrible threat to officers.
Law enforcement officers tell me that they need more narcotics investigators and better training for officers. They want to see local, state, and federal agents sharing intelligence and resources to respond immediately to opioid events, allowing them to quickly dismantle drug organizations. They also stress the importance of education, especially in schools, that can stop illegal activity before it starts.
I fully endorse, and I will lobby the General Assembly for, the statutory and financial support law enforcement needs.
Government databases to track your Sudafed are not the solution. Those have been tried, and the problem still grows, because they fail to address the real issue--the over-prescription of opioids.
Health care providers in South Carolina must lead a culture change in pain management, and we must support law enforcement who tackle the daily threat to our communities.
We also must remember that those who suffer from addiction need our love and support. They are those of whom Jesus spoke when he said, "Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me." That can be the most important culture change of all.
The writer is Lieutenant Governor of South Carolina and serves the Anderson community as a registered pharmacist at the family-owned Bryant Pharmacy and Supply.