The new FDA commissioner, Dr. Scott Gottlieb, has described America's opioid crisis as a, "public health emergency on the order of Ebola and Zika" (Senate confirmation hearing, April 5, 2017). In its recently released proposal, the FDA is asking doctors to cut back on writing prescriptions for opioids by turning to acupuncturists and chiropractors for non-pharmacologic approaches to pain control. "[Health providers] should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management," advised the FDA.
For some time now, acupuncturists and chiropractors have been lobbying various government agencies to take this kind of action.
The new FDA guidelines have yet to be finalized. Doctors and other practitioners, drug makers, and the general public have until July 10 to submit their comments.
It's undeniable that there's a crisis in opioid abuse. According to the CDC, more than 52,000 deaths in the United States were due to drug overdoses in 20l5. That's triple the number of drug-related deaths in 1999. Two-thirds involved an opioid. U.S. sales of prescription opioids have dramatically increased by more than 300% over the past two decades, "with more than half for chronic non-cancer pain" (The Lancet).
It's easy to jump to the conclusion that doctors are to blame for the opioid crisis. If that were true, the solution would be simple: Get doctors to stop writing prescriptions for opioid painkillers.
"The single biggest question regarding the opioid epidemic remains: Is it driven mainly by patients who become addicted to their prescriptions? Or are recreational users the underlying cause?" (Josh Bloom and Alex Berezow, American Council on Science and Health, commenting in The Wall Street Journal, May 16, 2017).
To this day, the underlying cause of addiction remains unclear. Providing evidence contrary to popular belief, a Cochrane review of 26 studies found that fewer than 1% of patients taking prescribed pain medication became addicted.
"This points out the folly of overly strict laws now being enacted that limit prescriptions to one week, or even less. All this will do is cause patients to suffer and have little or no impact on addictions," say Bloom and Berezow. They argue that epidemics of illegal drug use and opioid abuse "cannot be pinned on pill-happy doctors or unscrupulous pharmaceutical companies."
Any government response to the opioid epidemic must avoid the unfortunate consequences of blaming doctors and their patients. Access to pain-relieving drugs should not be denied to patients who are indeed suffering, and doctors should not fear losing their licenses for prescribing pain-killing opioids when they're needed.