Access to Medications in an Opioid-Crisis Era

3 min read

The United States is currently in an epidemic that is often referred to as the “opioid crisis.” This has led to a change in the availability and access of opioid-containing pain medications to individuals battling chronic pain.

What is are opioids?

The term opioid refers to a class of drugs that act on opioid receptors in the body. These receptors help control pain and often produce pleasure. This is why opioids can be addictive. Opioids can be legal and prescribed by a doctor, such as oxycodone, codeine, morphine, and hydrocodone. Other opioids, including heroin, are illegal. The drug fentanyl is a synthetic (or man-made) opioid drug.¹ Fentanyl can be prescribed and regulated by medical professionals, however, it can also be illegally made and manufactured. Illegally produced fentanyl can be extremely potent, and very small amounts can lead to an overdose. Illegally created fentanyl can also be laced or put into other illicit drugs, which can make them even more dangerous.^1,2

What is the opioid crisis?

According to the Centers for Disease Control and Prevention (CDC), in 2016 alone, nearly 12 million Americans aged 12 and older said they had misused an opioid within the last 12 months.³ In addition, it has been estimated that around 115 Americans die each day due to an opioid-related overdose, and 350,000 individuals have died between 1999-2016 as a result of an opioid-related overdose.^4,5 These numbers are several of the many statistics that have led experts to believe that opioid misuse is currently a national health crisis.

The opioid crisis is thought to have grown in three waves. The first was in the 1990s with the introduction of opioids to the market, and a lack of awareness on their addictive properties. The second and third waves came in 2010 and 2013, as heroin and illegally-made fentanyl gained popularity as street drugs.^2,4,5 In order to combat the opioid crisis, many national, state, and local organizations have created programs designed to help those who are addicted, educate others on addiction, fund research into alternative pain relief options and addiction medicine, and set stronger regulations on opioid prescribing.

How is the opioid crisis changing access to medications?

As mentioned, many regulations and organizations are being created in the United States to help fight the opioid crisis. As of late 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act has been passed that will provide resources to expand research, regulation, and support for those affected by the opioid epidemic, and to prevent its further spread.⁶ However, aside from this national act, the majority of regulations around opioid prescribing are at the state level. Some states have well developed and strict regulations for who can prescribe opioids and in what context, while other states have none. If you live in a state with strict regulations, it may be harder to gain access to these medications.

Guidelines for providers

In order to create a more standardized method of prescribing opioids, the CDC has created a set of guidelines for providers to use when considering a potential opioid-containing treatment plan for an individual in pain. There are 12 guidelines in total, and include recommendations such as checking the PDMP (prescription drug monitoring program) database to check an individual’s current prescriptions across their area, starting with the lowest dosage of opioids possible when starting treatment, and maintaining a close follow-up schedule to determine if the harms of treatment are ever outweighing the benefits.⁷ Due to the opioid crisis, many providers will try to find alternative methods of long-term pain relief before creating a plan that includes opioids.

Non-opioid pain relief options

As mentioned, opioids are not meant to be the first option for pain management. If this is the first time you and your provider are working together to create a pain management plan, it’s possible that they may first suggest starting with non-opioid pain relief alternatives or using non-opioid pain relief options in addition to opioid therapy. Some of these options include, but are not limited to:⁸

Acetaminophen
NSAIDs (nonsteroidal anti-inflammatory drugs: aspirin, ibuprofen, naproxen)
Gabapentin/pregabalin
Antidepressants (tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors)
Topical agents (lidocaine)
Acupuncture
Yoga
Meditation
Massage

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dgerbing Member
I have been on pain meds for 8 years but not the bad ones. No oxycodon for me. It was offered and i said no. You couldn't pay me. I have been on hydocodone. And it is not a high drug which is good. No wanting that. And the non narcotic i have tried have done nothing but i take so they don't get angry
1. Bondy Member
 <inline-mention username="dgerbing" user-id="3980730"/> well I've found that hydrocodone is the only one that works well for pain, has no side effects to me, and is very reasonably priced. The way I feel at this moment, I would risk getting addicted,even though I've had it for different things throughout the years and would save unused for emergencies for years even. 
2. dgerbing Member
 <inline-mention username="Bondy" user-id="4723979"/> I agree. The government and their taking things away from those that really need it are rediculus. Those to that overdose will find away using what is available. We should have a right to choose what we put in our bodies. Now if medical was legal here it would be better. And safer, also safer than alcohol.
lilmsunderstood Member
While this article is good and full of information, it does leave out a great deal of information as well. For those of us who have been affected by the CDC 2016 guidelines, which were actually only written for Primary Care Physicians treating pain patients like a Pain Management Physician. It somehow got blown way out of proportion and handed down as the law of the land. Now we are seeing not only the CDC but some of the States that handed down stringent opioid dosing guidelines have to clarify their statements but make it understood that those of us who have had no other viable option but opioid therapy for pain management should not continue to be punished due to the continual self harm others decide to do to themselves. I have personally tried many other non- opioid therapies for my progressive MS, Fibromyalgia and fused spine L2-S1, too no avail. I hoped the intrathecal pain pump would be the answer to my prayers, eliminating the need for oral medications that obviously are terribly harmful to my liver and kidneys, it tried to kill me and cost me 8 additional surgeries. I understand the need to fight this "opioid crisis" but the Oxycontin Manufacturers just simply aren't to blame. I was diagnosed in 2003, the only pain medication I had ever been prescribed prior to my MS was Lortab after surgery and childbirth. I personally never, ever saw any commercials for any of these opioid pain medications streaming on my television, I wouldn't have had the first clue to ask my doctor about them. The first time I was prescribed any of them, very early on in my illness, I had to look them up online to see what it was I was being prescribed. It is not their fault anyone started abusing anything! I've never felt the need to try to see how many of pills it would take to be pain free, it would clearly require a great deal. As long as I am at a level I can tolerate and function, that's all I need. My pain management physician unfortunately did not behave ethically throughout this CDC guideline BS, he made sweeping, drastic reductions to chronic pain patients that caused good people serious damage, and he did it all without even discussing it with them or telling them it was coming. If you are a chronic pain patient you must, must educate yourself on every law on the state and federal level and get to know your legislators as they can be great advocates on your behalf! Hugs to you all!!!
1. Bondy Member
 <inline-mention username="lilmsunderstood" user-id="4012085"/> yes I haveS plus spinal stenosis
Bondy Member
Thank you for that. I will brush up on state laws