This week, Here & Now is producing a series about the prescription opioid and heroin epidemic that is hitting many parts of the country. Today, host Robin Young talks with Dr. Andrew Kolodny, chief medical officer at Phoenix House, a non-profit drug and alcohol rehabilitation organization, and co-founder and executive director of Physicians for Responsible Opioid Prescribing.
Dr. Kolodny discusses the role that legally-prescribed opioids are playing in this epidemic, and what he thinks can and should be done to address it.
"The reason that we have a severe epidemic of opioid addiction is that we have overexposed the U.S. population to opioid pain medicine," says Dr. Kolodny. "The people who are using heroin are out there using heroin because they were first addicted to opioid pain medicines."
Dr. Kolodny says the overprescribing is due in large part to a marketing push by the makers of prescription opioids. Here & Now reached out to PhRMA, the trade group that represents pharmaceutical research and biopharmaceutical companies in the U.S., which sent the following statement:
"PhRMA and its members view appropriate prescribing practices and patient education as important steps to help address the diversion, misuse and abuse of prescription medicines. While more than 90 percent of the prescription medicines most susceptible to abuse are generic, helping to ensure the appropriate use of these medicines while also ensuring access for patients with legitimate medical needs is a critical priority for the innovative biopharmaceutical industry. To meaningfully address this critical public health crisis, we will continue to emphasize prevention and treatment for those who suffer from prescription drug abuse and addiction issues and support a range of policy approaches, including strengthening regulations aimed at addressing 'pill mills,' expanding and improving awareness, education and training related to appropriate use and prescribing practices and prescription drug abuse, the enhanced use of state-run electronic databases to better identify potential doctor shoppers and ensure appropriate prescribing, and efforts to foster the development of abuse deterrent formulations of prescription medicines that can help prevent abuse and misuse."
Interview Highlights: Dr. Andrew Kolodny
Characterizing the opioid addiction crisis
"The reason that we have a severe epidemic of opioid addiction is that we have overexposed the U.S. population to opioid pain medicine. These are pain medications like hydrocodone and oxycodone, which are drugs that come from opium in the same way that heroin comes from opium. In fact, the effects produced from hydrocodone and oxycodone are indistinguishable from the effects produced by heroin so that when we talk about opioid pain medicine, we’re essentially talking about heroin pills, which doesn’t mean we should never prescribe them. These are very important medicines to ease suffering at the end of life. These are also very useful medicines when used for a few days after major surgery. Unfortunately, the bulk of the consumption of opioids in the United States, the bulk of the prescribing is not for those indications. Most of our use is for conditions where opioids are much more likely to harm patients than help them – conditions like low-back pain, fibromyalgia, chronic headache, and the reason that we wound up overexposing our population to these highly addictive drugs is because beginning in the late 1990s, the medical community started to increase its prescribing and as the prescribing took off, it led to paralleled increases in rates of addiction and overdose deaths."
Why are these medications being overprescribed?
"It’s actually people who are 45 to 54 years old that are dying of drug overdoses at a far higher rate than the young people who are switching to heroin."
"The problem that we're dealing with, the reason that physicians are overprescribing these highly addictive medications – and it’s not just physicians, it’s nurse practitioners, it’s dentists – was in many ways they were responding to a brilliant marketing campaign that misinformed them about how addictive these drugs are and led the medical community to believe that the compassionate way to treat just about any complaint of pain was with an opioid prescription. So doctors began to hear from their professional societies, from their hospitals, from their medical boards, from the joint commission which credits hospitals. They started to hear from every different direction that the proper way to treat pain is with an opioid, and as they responded to that campaign, it led to a public health crisis.”
Who is affected?
"What we see really are two different groups. There is a group of young people - you know, 40 and under – who have become addicted to opioids either through recreational use or medical use. Because that group is young, because they don’t have many medical problems, they tend to have a difficult time maintaining their supply once addicted, visiting doctors, and that's a group that pretty quickly turns to the black market. And if you're buying the pills on the black market, they're very expensive."
"But there’s another group that’s in their 40s, 50s, 60s, 70s - these are individuals who mostly have become addicted to opioids through medical treatment. And because they're older, because they tend to have multiple medical problems or suffer from chronic pain, this is a group that can usually get all of the pills they need from doctors. And what's interesting, and rarely known, is that the group with the highest rate of drug overdose death in the United States - it's not the young folks who are switching to heroin. It’s actually people who are 45 to 54 years old that are dying of drug overdoses at a far higher rate than the young people who are switching to heroin. In many cases, these are individuals that are overdosing on pills that were legitimately prescribed to them and overdosing in bed, next to their spouse.”
- Andrew Kolodny, M.D., chief medical officer at Phoenix House, a non-profit drug and alcohol rehabilitation organization with programs in 10 states. He's also co-founder and executive director of Physicians for Responsible Opioid Prescribing and a senior scientist at the Heller School for Social Policy and Management at Brandeis University.
This segment aired on September 9, 2015.