The Centers for Disease Control and Prevention state that almost 36% of all U.S. opioid overdose deaths involve a prescription opioid.

From 1999 to 2017, more than 200,000 people died from prescription opioid overdoses. 17,000 of those deaths occurred in 2017.

Dr. Patrick Harper, a physician with Lawrence Pain Specialists, said there are several factors that have contributed to the current opioid epidemic. One factor was aggressive marketing towards physicians.

In 1980, a one-paragraph letter to the editor of the New England Journal of Medicine stated a conclusion that “development of addiction is rare” with opioid medications. This letter has been cited more than 600 times, with the majority of the citations referencing this as proof addiction is rare.

“Because of this letter, one which the authors later said that they had no intention of it being used in this manner, combined with the aggressive marketing campaign by pharmaceutical companies, physicians were led to believe that opioids were not too addictive,” Harper said. “They thought opioids were safe to prescribe for chronic pain cases and then they realized there were a lot of risks. We are now in a stage of helping patients dial back from an issue that began years ago.”

Opioids are extremely powerful pain medications. They can be beneficial when being prescribed for an acute problem, such as post-surgery pain, but when prescribed for a chronic pain — one that lasts longer than three months — the risk of opioids can outweigh the benefits and become very dangerous.

“Even one prescription is enough to get someone addicted to opioids,” Harper said. “We have to be careful prescribing, even when prescribing them in acute cases. There are still risks that need to be discussed.”

There are many different risks with opioids, including tolerance, dependence and addiction.

Harper said everyone who takes opioids will experience tolerance and dependence to some degree. Tolerance happens when the body gets used to a certain level of medications and the same dose doesn’t result in the same level of pain relief.

In dependence, the body gets used to having the drug and the patient can experience withdrawal symptoms that can be very unpleasant if they stop taking the medication.

Addiction is characterized by behaviors where you do not have control over your usage. Everyone is at risk for addiction, but some are at higher risk than others.

Patients with addiction continue to use the medications, even if it results in harm. Signs of addiction can include wide changes in mood, social isolation, changes in sleep, financial problems and new problems with work or law enforcement.

In addition to these signs, side effects of opioid medications include decreased breathing, sleepiness, constipation and decreased testosterone. Some of these side effects, such as sleepiness and decreased breathing, can be increased significantly when taking other substances such as alcohol, benzodiazepines and sedatives. This is why it is very important to tell your physician every medication that you are taking.

“According to the CDC, on average, 46 people die a day from prescription opioids,” Harper said. “It is important to assess the risk for addiction. Personal or family history of substance abuse can play into this. It is important to note that just because someone is at high risk for addiction doesn’t mean you don’t prescribe opioids, but we just have to be much more aware of what to do if problems arise.”

Harper said there are many alternatives to opioid medications, but that it can be difficult to convince someone that prescription opioids can cause more harm than good. He thinks it sometimes comes down to patient education about the prescription or on the proper and safe disposal of the medications. It is also important to identify resources in the community that are available to help with opioid addiction.

Kyle Eichelberger, a pharmacist at the LMH Health inpatient pharmacy, said the stewardship committee at LMH Health is working on hospital initiatives to prescribe as few opioids as possible and educate patients on proper disposal of unused medications.

“In our meetings, we have developed goals for the committee,” Eichelberger said. “Some of these goals are pain management, patient education, monitoring opioid usage statistics, where we are as a hospital on these metrics and doing overall quality and safety measurements.”

The committee partnered with LMH Health physician Dr. Adam Goodyear and Dr. Shawn Jackson with Lawrence Anesthesia to discuss knee and hip replacements and to look at the medication prescribed. They wanted to see if current medications could be replaced by non-opioid medications such as Tylenol.

“The committee is continuing to look into clinics, such as the Emergency Department, that prescribe opioids to check on their prescription policy,” Eichelberger said. “Most won’t prescribe opioid medication to start, but if they do, the prescription only lasts for three days. We are assessing patients throughout the hospital to check on them and see what their pain levels are, monitoring for changes and determining if they are at risk for any kind of addiction.”

If you are prescribed an opioid medication, it is advised that when you are able to stop taking them, you do so. Eichelberger said they are constantly completing trainings to stay up to date with new changes. In these trainings, they have learned about many resources for drug takeback options.

“There used to be only a few places where you could dispose of medications around Lawrence,” Eichelberger said. “Now there are many more, and LMH Health is getting a dropbox intended for disposal of unused or expired medications in the next month, thanks to a generous grant from DCCCA. This is great for patients because when you are done with your medications, it is important not to let them just sit around. Get rid of them as soon as possible.”

Eichelberger said DCCCA also provided a grant to assist in obtaining medication disposal bags. The bags are available to pick up for free in the LMH Health System Pharmacy.

“These disposal bags are awesome,” Eichelberger said. “You are able to put your medications in the bag, add a little water, shake them and then dispose of the pouch in the trash. They deactivate the medications and are an environmentally friendly option.”

He said that education on the medications and proper disposal is something the group is working to promote across the hospital with their patients. The stewardship committee has been working hard to spread awareness to prescribers and help reduce overall prescription of opioid medications.

“Our goals for safety are driving our initiatives,” Eichelberger said. “We are always looking for different areas to better ourselves and get more data. We want to continue to put the patient first. By bettering ourselves, we are able to more successfully educate staff and patients about prescription opioid usage.”

— Jessica Brewer is the social media and digital communications specialist at LMH Health, which is a major sponsor of the Lawrence Journal-World’s Health section.