Issues such as homicide, motor vehicle deaths and infant mortality often fill the news, but addiction has taken more lives overall. In fact, both prescription opioids and heroin use end more lives in Wisconsin than car accidents.
Experts say that one contributing factor is the ease of access to prescription pain killers. "Every year, 9 billion pills of hydrocodone are prescribed in the United States and roughly half of those are actually taken. So every year, another 4.5 billion pills of hydrocodone (and that's only one of the many opiates) are building up in people’s medicine cabinets," says Dr. Michael McNett. He's a member of the Medical Society of Milwaukee, a Pain Management Physician, leader of the Comprehensive Pain Program team at Aurora Health and an Opioid Task Force Member.
Amidst what he describes as an "appalling" increase in the number of deaths due to substance abuse, McNett notes that doctors were not always so quick to prescribe opioids.
"When I was initially trained to treat pain in my residency [in the 1980s], we really thought of opioids as very dangerous. They worked well, but we were really afraid of creating addiction," he says.
McNett also worked in a methadone treatment center during this time, experiencing addiction first hand "on a very very blatant level."
However, he concedes that doctors not only have to work on observing their patient's intake of pain medications, but also face outside pressure to continue prescribing these drugs. Regulatory agencies, such as Joint Commission, supervise and certify hospitals in order to authorize the billing of insurance companies.
"Joint Commission is really aggressively making (doctors) do this whole 'pain as a fifth vital sign' thing and be aggressive about treatment. And other physicians out in their offices are subject to patient satisfaction surveys, and if they don't get a good patient satisfaction survey their salary gets cut," McNett explains. "So doctors are really being penalized for not cooperating and giving more pain management."
McNett is currently working on changing regulations that affect the training doctors need to better recognize addiction in their patients, something that wasn't emphasized until recently. Starting in April of 2017, every physician will need to check the Prescription Drug Monitoring Program (PDMP) before writing any prescription for a possibly addictive drug to a patient. In addition, the State Medical Examining Board recently published guidelines on opioid prescribing that guide physicians throughout the state, including mandated training for license renewel.
"There are some doctors that feel like we're really cramping their style, and who are we to tell them how to practice medicine?" says McNett. "My response to them is, we should all be following medical information."
He believes the worst aspect of the crisis is evidence showing the ineffectiveness of opioids in treating pain.
"We have seen a quadrupling of the amount of opioids that have been prescribed in the last ten years along with a corresponding quadrupling in deaths, and the amount of pain reported by Americans hasn't changed at all," McNett explains.
In fact, he notes a recent meta analysis showing patients who are given one Advil with one extra Strength Tylenol after surgery, are "three times as likely to cut their pain in half as you are with the amount of oxycodone in three percocet."
"As I have learned how ineffective (opioids) are and how dangerous they are, I've really felt the need to not only change my own practice but to really champion the needs to change practices throughout our medical community," says McNett.
"Addiction's like a computer that's caught a virus. We don't blame the computer, we just need to take care of the virus. I think there's a really compelling role for physicians to play in learning how to provide effective treatment for addiction to the patients that they care for."