February 1, 2017
State health official prescribes steps to fight opioid crisis
A leading Washington state health official on Tuesday urged medical and dental providers at a UW dental research forum to support more stringent prescribing guidelines and other measures to address the opioid abuse crisis.
Dr. Gary Franklin, medical director of the state’s Department of Labor and Industries, called it “the worst man-made epidemic in medical history,” citing more than 200,000 deaths and hundreds of thousands more overdose cases.
Franklin, who is also a research professor in the UW’s School of Medicine and in the Department of Environmental and Occupational Health Sciences, said the state has been a national leader in addressing the problem, but that other steps must be taken, especially in states with more permissive prescribing regulations.
“This was the saddest thing I’d ever seen,” he said as he discussed the problem at the School of Dentistry’s annual Research Day at the HUB, where he was keynote speaker. “Imagine that: You come into the system with a low backache, and you die?”
Along with repeal of permissive laws on opioid use, he called for states to adopt the Centers for Disease Control and Prevention’s tougher guidelines for prescribing opioids, and leveraging the power of large public health-care purchasing programs such as Medicaid.
Franklin also called on providers to protect children and teenagers by limiting initial opioid prescriptions to a maximum of three days or 10 tablets and employing only short-acting opioids for acute use. After that, he suggested, providers should either stop such medication or, if it was still deemed absolutely necessary, require patients to sign an informed consent so they would be fully aware of the medication’s risks.
In addition, he also suggested ways to improve the medical system’s capacity to treat pain and addiction:
- Optimizing overdose case management
- Employing behavioral therapy or graded exercises to help patients manage pain
- Using medication-assisted treatment for patients with opioid use disorder
- Improving patient access to expert advice on pain and addiction through resources along the lines of the UW’s TelePain, a weekly audio and videoconference consulting service for medical providers
“This is an emergency, and it’s going to take a huge effort in [the dental community] and in our state to reverse this thing,” he said.
Franklin noted the difficulty of tackling the crisis, starting with this: “There’s a problem treating pain. Doctors don’t have a lot of alternatives.” However, he also noted that while opioids have unmatched effectiveness in treating severe acute pain, studies show that they fare no better than less powerful and non-addictive drugs such as NSAIDs and acetaminophen in treating long-term pain.
Opioids, he said, should not be used routinely to treat conditions such as musculoskeletal pain, neuralgia or fibromyalgia.
He said that opioid users not only face a high risk of addiction and dependency, but develop rising tolerance for their pain-relieving effects. At the same time, they don’t develop a similar tolerance for the drugs’ depressant effect on the respiratory system, which is why respiratory failure is the usual cause of death by opioid overdose.
In the course of tightening regulation of opioid use, Washington state saw a 44 percent decline in deaths from unintentional prescribed opioid use from 1995 to 2015 – the largest such decline in the United States, he said.
Yet even as the state has reduced opioid-related deaths, he said, there has been a continuing spike in heroin-related deaths, mostly among people ages 18 to 30. The majority of opioid-related deaths have come among people ages 35 to 55.
Also troubling, he said, was a 2015 study that linked legitimate opioid use during high school – often for sports injuries – to a 33 percent increase in the risk of opioid misuse after graduation.