A golden opportunity to fight opioid addiction

If we want a different result in our fight against opioid addiction, we can’t continue using the same downstream playbook and expecting different results. While supporting those already suffering from substance use disorder is crucial, the federal government’s approach to the epidemic must change to prevent addiction before it begins.

Over the past decade, lawmakers on Capitol Hill, community leaders, key agency officials, and now multiple Administrations have taken steps to reduce rates of opioid-related drug overdose deaths in our country. These efforts share something in common – they haven’t worked.

The opioid crisis is resilient to downstream efforts aimed at individuals and families in crisis. That’s why – despite worthwhile efforts to ensure widespread availability of naloxone, supporting our nation’s first responders, and providing access to mental health treatment services – we are losing 80,000 Americans a year to the opioid crisis. That is 220 Americans dying every day from an opioid related drug overdose.

We need to fundamentally change our approach to the opioid crisis. Rather than focus on downstream efforts, we must consider what we can do to prevent opioid addiction. In doing so, we have a real opportunity to save lives.

As an orthopedic surgeon, I understand that, for some, first exposure to opioids can come after a medical procedure. I often prescribe opioids to my patients to help them manage postsurgical pain and I’m not alone. 90 percent of surgery patients in the United States receive opioids to manage postsurgical pain. Unfortunately, this leads to millions of patients becoming newly persistent opioid users every year.

Many may be surprised to learn that, when it comes to pain management, there is relatively little choice. As a surgeon, it is not up to me whether or not I provide opioid-sparing pain management. It is certainly not up to the patient or their family. Instead, these decisions are made based on short-term economic considerations. As a result of this and our status quo bias, opioid-based pain management is the standard of care in this country.

This doesn’t have to be the case. There are a variety of other effective, safe, and non-opioid options that can help patients manage postsurgical pain. Unfortunately, these options are often out-of-reach for me, my patients, and their families due to out-of-date reimbursement rules, which prioritize the administration of opioid-based pain management.

Given the current opioid crisis, this is an oversight of epic proportions.

Fortunately, help is on the way. Last year, federal legislation was passed that would significantly expand access to and use of non-opioid pain management approaches for surgery patients. The legislation – the Non-Opioids Prevent Addiction in the Nation (“NOPAIN”) Act – updated federal reimbursement policies to ensure access to non-opioid pain management approaches in hospitals and ambulatory surgery centers across the country. Importantly, this legislation is an attempt to prevent opioid addiction where we can by minimizing unnecessary exposure to opioids.

This legislation, however, is not scheduled to go into effect until 2025. That means that, as a surgeon, I may need to wait nearly two more years before I can provide my patients access to non-opioid based pain relief. In this time, more than 100 million surgical procedures will take place across the country and millions of patients will be unnecessarily exposed to opioids.

And more than 100,000 more Americans will die of an opioid related drug overdose.

The Centers for Medicare & Medicaid Services (CMS) has the authority to bring non-opioid options to patients much sooner than this. In doing so, CMS and the Administration have a real opportunity to make a meaningful impact on the opioid crisis in the nation. Doing so would prevent opioid addiction for millions of Americans.

Such a step would constitute a different approach to combatting opioid addiction in our nation. It’s well-past time that we tried something different. In doing so, perhaps we can see different results and start to reduce rates of opioid-related drug overdose deaths in the country. Put simply, it’s a chance to save lives.

It’s an approach that makes a lot of sense to overcome our status quo bias.

Dr. Uma Srikumaran is chair and associate professor at Johns Hopkins orthopaedic surgery at Howard County General Hospital.