In previous posts we discussed the opioid crisis’s impact on society, the lack of evidence supporting the use of opioids for chronic pain and what alternatives exist to help patients in chronic pain while avoiding the harmful effects of prescription opioids. As public awareness of the epidemic increased and the government produced legislation in an attempt to curb the misuse of opioids, the number of overdose deaths began to plateau in 2015 and even decreased by 4.1% between 2017 and 2018. But in 2019 we began to see deaths from opioids begin to rise again with an increase in 6% over 2018. Then 2020 came and the numbers were startling to say the least; total drug overdoses up 29.4% versus 2019. The issue was very widespread, almost every state in the United States had an increase in deaths, with 24 states and the District of Columbia having over a 30% increase.
The increase in deaths were primarily driven by the increased prevalence and availability of fentanyl, a synthetic opioid which can be 50 times more potent than heroin. The COVID -19 pandemic also played a significant role in the increase in overdoses as people were dealing with economic shock, social isolation and increased mental health distress. Decreased access to addiction support services and inability to see medical providers to obtain medication that require face to face visits also increased the use and misuse of either prescription medications or illicit drugs. 2020 also saw a rise in illicit drug use from drugs like cocaine, methamphetamine and heroin.
Now that we are hopefully rising from the depths of the pandemic, what can be done to get us out of this downward spiral of opioid abuse and accompanying overdose deaths? Is this a problem where there continues to be more questions than answers? The Centers for Disease Control continues to push education, research, medical provider and healthcare system support and public awareness as the solutions to decrease the frequency of overdose deaths and general misuse. The American Medical Association has recommended improved access to harm reduction services including naloxone, sterile needle and syringe exchange services, and drug checking supplies. They are also asking insurance organizations to remove arbitrary opioid restrictions on some patients that benefit from proper opioid use, believing this will cause fewer patients to seek more illicit and potentially more dangerous alternatives.
One tiny bright spot in the opioid crisis has been in the workers’ compensation industry. According to the Workers’ Compensation Research Institute (WCRI), prescription drug monitoring programs have succeeded in decreasing the excessive prescribing of opioids along with the potential of abuse. These programs allow healthcare providers to access state-level databases with a patient’s previous prescription history before prescribing controlled substances.
Overall, these programs led to a 12% decrease in the likelihood that injured workers prescribed opioids would receive them on a longer term basis. Unfortunately, there has not been a significant decrease in the likelihood that an injured worker will receive an opioid prescription after an injury, it only reduced the amount of prescriptions received, hopefully reducing the likelihood of abuse. That being said, there is still substantial work to be done.
As we have stated in previous posts, physical therapy can be a safe alternative to the use of opioids when treating chronic musculoskeletal pain. Physical Therapists are trained in performing thorough musculoskeletal evaluations and are able to design condition specific treatment plans to help patients deal with their pain in a safe and effective manner.
Treatment plans consist of, but are not limited to exercise, manual therapy, stress management, sleep hygiene and pain neuroscience education. Physical Therapists are looking to design these treatment plans with the intention of getting to the root causes of the patient’s pain. As opposed to providing a short-term solution like an opioid pain medication, therapists are trying to provide strategies for actively managing and preventing future pain issues.
It appears the opioid crisis is not going away and in some circumstances is worsening. As legislation and regulations continue to attempt to curb the misuse of prescription opioids, health care providers need to continue to become educated along with educating their patients on safe alternatives to manage their pain. Physical Therapy can be one of the safest and most effective methods of managing a patient’s pain conservatively. For more information on how Physical Therapy can help you or your injured workers, contact Results Physiotherapy at https://resultspt.com/request-info
