As a junior neurosurgery resident, I have already cared for too many patients whose lives have been destroyed by drug abuse. Consider the 22-year-old being whisked to the operating room for a severe traumatic brain injury (TBI) caused by a drug-induced high-speed motor vehicle accident. Or the 35-year-old undergoing baclofen pump placement for spasticity and contractures caused by heroin overdose and anoxic brain injury. Or the 40-year-old patient with failed back syndrome frantically pleading for an opioid prescription, despite obvious addiction and repeated abuse of the medical system. These unfortunate cases, all-too-well-known to every neurosurgeon, call our attention to the larger societal and medical challenge of drug addiction.
Nationwide, millions of patients use illegal drugs and millions abuse prescription drugs, especially opioids. The connection between prescription opioid use and illegal drugs is strong. For example, it is estimated that at least 80 percent of people who start abusing heroin abused prescription opioids before starting to abuse heroin.
As the gatekeepers of prescription drugs and as societal leaders, physicians must play an active role in addressing this complex issue at the national level. The American Medical Association (AMA) has led the way by launching an aggressive campaign targeting the reduction of opioid abuse. Recognizing the urgency and serious impact of this issue, the AANS/CNS Pain Section appointed Jennifer A. Sweet, MD, assistant professor of neurosurgery at the Case Western Research University School of Medicine and a practicing neurosurgeon at the University Hospitals in Cleveland, Ohio, to serve on the AMA’s Task Force to Reduce Opioid Abuse. The purpose of the task force is to reduce the nation’s burden from the inappropriate prescribing of opioids, and the growing crisis of heroin overdose and death. Through this effort, the AANS and CNS are encouraging neurosurgeons to use state-wide drug monitoring programs; enhancing neurosurgeon education on effective, evidence-based prescribing practices; and supporting expanded access to naloxone in the community, among other initiatives.
Neurosurgeons must also become involved in our local communities. For example, Pennsylvania has been severely affected by drug abuse. A sobering 2014 report titled Heroin: Combating this Growing Epidemic in Pennsylvania reveals that in Pennsylvania heroin overdose deaths have increased by 470 percent (rising from 2.7 to 15.4 per thousand individuals annually) over the past two decades, and currently more adults ages 20-44 are dying from drug overdoses than from motor vehicle accidents. Indeed, Pennsylvania consistently ranks in the top 10 states in the nation for drug-related overdose deaths.[3,4]
In response, state legislative and medical initiatives are in development. For example, in 2014 in Pennsylvania, the Achieving Better Care by Monitoring ALL Prescriptions Program (ABC-MAP) Act — which establishes a statewide drug monitoring program that will assist in identifying prescription fraud, doctor “shopping” and improper prescribing and dispensing practices — was enacted into law. In 2014, Senate Bill 1164 amended existing legislation to help make naloxone available to first responders in the field, including law enforcement and fire department personnel. Additionally, in 2015, House Resolution 363 was introduced to establish a Heroin and Opioid Eradication and Treatment Task Force. Finally, the Pennsylvania Medical Society collaborated with the state to publish excellent guidelines on the use of opioids to treat chronic non-cancer pain.
Neurosurgeons can learn more about their own state’s prescription drug monitoring programs by searching the National Alliance for Model State Drug Laws website. They should also complete continuing medical education (CME) courses and webinars on preventing opioid abuse and safe prescribing practices. These and other resources are available on the AMA’s website. Working together we can help end opioid abuse.
1. http://www.cdc.gov/vitalsigns/heroin/index.html (accessed October 2015)
2. Muhuri et al. Association of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Center for Behavioral Health Statistics and Quality. 2013.
3. The Center for Rural Pennsylvania. Heroin: Combating this Growing Epidemic in Pennsylvania. 2014
4. Schwarz. Drug overdoses surpass car accident deaths in Pennsylvania. Pittsburgh Post-Gazette. June 23, 2015.
5. http://www.legis.state.pa.us (accessed October 2015)
6. Pennsylvania Guidelines on the Use of Opioids to Treat Chronic Noncancer Pain. Pennsylvania Medical Society. 2014.