San Francisco Health Officials Respond to FDA's Move to Crack Down on Prescription Opiates

Categories: Drugs

Addiction is the painful part of pain killers
In the wake of a national prescription pain pill epidemic, which has resulted with millions of abusers and thousands of overdose deaths, it seemed like a no-brainer when the FDA announced recently that prescription opiates have a high risk of abuse, overdose, and death, and, thus should be prescribed sparingly.

But a deeper look at the federal agency's announcement reveals a shift occurring in the healthcare system that moves away from opioids as a primary treatment for chronic-pain management and a turn toward alternative treatment options.

The FDA will now require drug manufactures to include new safety labels for extended-release, long-acting opioids, like oxycodone, morphine and fentanol, to clarify the risks of the highly addictive drugs, including a warning of opiate withdrawals for newborns due to prolong opiate use in the mothers. The agency will also be requiring opiate drug manufacturers to do more research and conduct more studies with regards to opiates.

Phillip Coffin, director of substance use research for the San Francisco Department of Public Health, says the FDA's crackdown on prescription pills is smart.

"It's a pretty meaningful move to shift away from relying on opioids as the first line, and sometimes solitary treatment, to other forms of rehabilitative treatment," said Coffin. "And healthcare providers do pay attention to what the FDA does."

The opiate push came in the 1990s as way to better treat chronic pain and improve a patient's function. At the time, opiates were underused, and most were not nearly as potent compared to what is available today. Because of this, the medical community wrongly assumed that the risk of addiction to opioids when used to treat chronic pain was rare, occurring in only 1 to 3 percent of patients, according to Coffin.

The growth of the opiate industry and the extend access was rapid, dozens of opioid formulations were created, and many of the alternative therapeutic treatment options were deemed too costly, thus many of the rehab clinics disappeared.

The second stage Coffin called the Oxycotin epidemic, which began in the late 1990s, early 2000s. The ballooning drug abuse that occurred then was thought to be the cause of a few "bad characters" misusing and diverting their opioid prescriptions. The blame was targeted toward bad patients.

By 2007 it was clear that prescription opioids were a real problem. The overdose rate tripled since the 1990s and the amount of pharmaceutical opioids purchased quadrupled since 1999, according to the Center for Disease Control and Prevention. The center estimated that in 2010 there were 12 million prescription pain abusers and more than 16,000 fatal overdoses.

San Francisco mirrored some of the national trends, with hospital emergency visits and overdose deaths jumping higher than previously seen, but the city was more prepared to handle the increases than most other cities because of robust drug treatment programs and good health policy, according to Alice Gleghorn, privacy officer with the County Alcohol and Drug Administer.

"We started initiating increased drug treatment availability for everyone, especially heroin, in 1997," said Gleghorn. "We beefed up our methadone maintenance"

The city has 3,500 treatment spots for opiate abusers, all methadone maintenance oriented. Seven methadone clinics serve the city, including three converted RVs that cruise to Sunnydale, Bayview Hunters Point and the Mission, to dispense the long acting-opiate. Another 20 to 25 health clinics also offer buprenorphine to treat heroin addicts, with about 250 people on it. Gleghorn said that buprenorphine is easier to kick than methadone.

She added that while she has seen an increase in patients who say their primary drug are opioids during intake admission, the numbers are still too low to know how effective drug treatment programs are for them.

Preventive measures are always the best policy.

"Risky drugs, not risky patients" is the stage we are at now, said Coffin, adding that the medical community must be careful as it transitions from opioids as the first line of treatment to therapeutic forms, like yoga, acupuncture and massage therapy.

"There are a 100 ways to do this wrong, and only a few ways to do this right," said Coffin."We need to change the way we prescribe opioids, and it's incumbent to do it in a way that doesn't cause more harm than has already occurred. It's critical we don't put patients at risk."

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