Fagan: Doctors, Big Pharma share blame in opioid crisis
By Jon Hawley
Saturday, March 17, 2018
To continue a team effort against what they described as a lethal opioid crisis, professionals from law enforcement, health care, social work and other fields gathered for a conference Friday at Museum of the Albemarle.
The Eastern Area Health Education Center, the Pasquotank-Camden Child Community Collaborative, and Trillium Health Resources hosted the conference. It featured Dr. Blake Fagan, an official with the Mountain AHEC in western North Carolina, and Dare County Sheriff’s Investigator Donnie Varnell to detail the best ways to handle what they said is an “epidemic” of drug abuse that kills thousands of Americans every year.
Part of the blame for that epidemic falls on doctors and pharmaceutical companies, Fagan said. That's because they've been far too willing to prescribe addictive painkillers, such as Percocet and oxycodone, to patients for chronic pain.
The end result is there are far too many opioid pills in circulation — in 2016, 660 million opioid pills were prescribed in North Carolina, Fagan said. Nationwide, he added, one third of adults received an opioid prescription that year.
The pills' prevalence has caused a surge in addictions, whether by patients or young people who steal their pills, and driven many more people to abuse heroin as they seek a cheaper fix, Fagan continued. That increases the risk of overdose and death even further because heroin is increasingly laced with even deadlier compounds such as fentanyl, he added.
Fagan said that older doctors — himself included — were taught as students that “there's no upper limit” to how many opioids a patient should be prescribed, even for recurring, otherwise manageable problems like lower back pain and migraines.
“Then they hired me on as faculty, and that's what I taught for a dozen years,” he said, yet there is “absolutely no data” in support of doing so.
“This is a hard thing to say, but, looking back at some of my patients, I believe that I addicted some of them,” Fagan said.
He also said that, starting in the mid-1980s, pharmaceutical companies started strongly promoting opioids' use to doctors, claiming scientific articles then found they weren't addictive. One of those articles was essentially a “letter to the editor” and not based on a quality study, he said.
Doctors and hospitals also came to consider pain as a “fifth vital sign,” increasing the pressure to curb pain with opioids.
Ironically, opioids can actually increase perceptions of pain in some patients and slow recovery after surgery, Fagan said. Simply prescribing ibuprofen and acetaminophen, as in Advil and Tylenol respectively, can be as effective or more in managing pain.
Opioids also cause long-lasting changes in the brain and disrupt the brain chemistry involved in natural feelings of reward, he said.
Fagan said patients should be prescribed opioids only for a few days after surgeries, and should be taught other ways to manage pain in the long term, including use of non-addictive medications, cognitive behavioral therapy, and physical therapy and exercise.
Fagan also said people may consider opioid addiction a choice, but it has to be treated as a disease, due to how it changes the brain and the severity of its withdrawal symptoms. Opioid withdrawal is like “the flu times 10,” he said, adding lawmakers and insurers should be willing to pay for long-term access to medications like methadone.
Varnell said law enforcement needs to continue supporting initiatives that, where possible, divert opioid and heroin users to rehabilitation and treatment. Addiction to opioids is so intense that law enforcement cannot expect the threat of jail to make someone stop using, he said.
“We can't arrest our way out of this,” he said.
Varnell also said he supports wide access to naloxone, which can save people from otherwise lethal overdoses, and needle exchange programs. Needle exchanges seem like encouraging people to abuse heroin, he said, but they protect first responders from getting stabbed and infected by hidden, dirty needles. They've also proven effective at encouraging people to get help, he added.