Treating Pain in the Opioid Epidemic

From parties to study sessions, students have increasingly found themselves falling victim to the dangerously ubiquitous nature of prescription drug abuse.  The universality of drugs like Xanax and Adderall has skewed the public’s perception of them as harmless, instead of as the potent medications they actually are. College students are not the only ones feeling the effects of this issue, however.  Rather to being isolated to a specific age group, opioid addiction has, over the years, come to affect millions of Americans on a wide spectrum of age, ethnicity, and socioeconomic status.

According to a study by the National Institute on Drug Abuse, the number of prescriptions for pain-relieving opioids in hospitals has increased by over 130 million, and all the while the number of unintentional deaths resulting from overdoses on these drugs has more than quadrupled since 1999.  These statistics are even more disturbing when viewed in the context of the 2015 National Survey on Drug Use and Health, through which it was discovered that nearly 5 percent of all Americans misused prescription psychotherapeutic drugs in the last year, with ‘misuse’ being defined as either the use of drugs that were not directly prescribed to the user or the recreational use of these drugs.

The National Survey also discovered that of all Americans who misused prescription drugs, 36 percent of them were prescribed these drugs by a medical professional.  Recent policy developments may play some role in the pervasive issue that the U.S. Department of Health and Human Services has dubbed, the “Opioid Epidemic.”  One specific facet of the Affordable Care Act involving patient-satisfaction surveys has come under considerable scrutiny for the possibility that it may be exacerbating this deadly dilemma.  This subsection of Medicare dictates the 1 percent slashing of government reimbursements to hospitals, with the only way to restore funds (or receive bonuses) being to amass high patient-satisfaction scores. The questionnaire is intended to act as a catalyzing agent for exemplary patient-doctor relations.

There are many intended benefits to implementing a patient-satisfaction survey in hospitals.  Without such a system, it becomes difficult to ensure hospitals are treating their patients with respect while also ensuring the patients’ health needs are successfully addressed.   As the old adage goes, happy patients are healthy patients.  By rewarding hospitals that keep patients both happy and healthy, the detrimental practice of maximizing efficiency at the cost of patient comfort can be discouraged.

The downsides of such a program may appear to be innocuous at first. The most immediately apparent caveat is that it encourages caregivers to focus more on ensuring that any given patient’s stay at the hospital is comfortable and luxurious, rather than solely focusing on effective treatment methods. However, a component of these surveys with potentially fatal consequences involves the questions regarding how well a patient’s pain was treated, and whether the hospital staff did everything in its power to address said pain.  In order to satisfy the requirements of these surveys and avoid jeopardizing hospital funding, many doctors can feel compelled to prescribe pain-relieving medication, as these treatment methods remain the easiest and most direct ways of reducing pain and discomfort.

The increased incentives involved with prescribing opioids to patients are a huge potential contributor to the growing number of Americans dealing with addictions to psychotherapeutic drugs.  Opioid abuse is commonly viewed as a gateway to even more dangerous street drugs such as heroin, widespread abuse of which often leads to rising crime rates and incarcerated populations.  In response, the burden of cost is placed on taxpayers, who are also funding the very programs that perpetuate this calamitous dilemma.

Many politicians from both sides of the political spectrum have formed an effort to remove questions regarding the effectiveness of pain treatment from the patient-satisfaction survey.  The ‘Promoting Responsible Opioid Prescribing Act’ has garnered support from several notable organizations in the health field, including the American Medical Association and the American Hospital Organization. The proposer of this legislation, Ron Johnson, a Republican senator from Wisconsin, stated in July 2016 that the bill is “an important bipartisan step that will expand resources and tools available to states and communities for prevention and treatment [of drug abuse].”

Six years after its passage, the Affordable Care Act remains one of the most divisive issues in an election cycle marked by polarization and schism.  The benefits of providing universal healthcare are constantly being weighed against issues of constitutionality and rising premium costs, leading to a debate of whether or not this program should be upheld.  However, often lost in the cracks of such a black-and-white dispute are the small and seemingly unobjectionable details that, in actuality, may have large and far-reaching impacts. Senator Johnson’s legislation, while important, may fall victim to perpetual pushback and gridlock.  This is common fate for marginal reform efforts on controversial and partisan issues like Social Security and welfare reform.

With the addictive nature and potentially life-threatening side-effects of most up-to-date pain medication, the inclusion of pain treatment as a metric for the quality of a doctor can have devastating effects on public health.  Even subconsciously, it can encourage medical professionals to overprescribe these pharmaceutical drugs in an effort to simultaneously satisfy the needs of the patient and the needs of the hospital.  Before this can be considered, there needs to be more research into alternative methods of pain treatment that limit the necessity of such addictive substances.  Until then, policy-makers must realize that doctors should be permitted to treat patients in the manner that is most beneficial on a case-by-case basis, without the added burden of worrying about how methods may affect hospital funding.

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