09/16/2016
September President's Message
Over the past decade or so, emergency physicians have served as witnesses to the growing opioid abuse epidemic. We’ve watched as aggravation over drug-seeking patients evolved into despair and a full blown public health crisis. We’ve been on the front lines as the steady drip of overdose patients became a torrent. And more recently, we’ve seen increasingly dangerous street drugs make their way into the hands of opioid users gripped by addiction. Across the country—and in Ohio in particular—heroin is being cut with more potent substances like fentanyl, which is 25 to 50 times stronger than heroin.
As if this development weren’t scary enough, a new, extremely potent opioid has recently made its way into batches of heroin around Ohio: carfentanil. I suspect many of you have seen this trend, either in the news or in your own emergency departments. And if you’re unfamiliar with carfentanil, it’s understandable: the drug—which is 10,000 times more potent than morphine—has no officially recognized purpose except to sedate elephants. In a single week in August, at least 96 heroin users overdosed on the synthetic opioid—in Hamilton County alone.
And as if that development weren’t scary enough, we have reached another unfortunate milestone in the opioid epidemic. Until recently, much of the illegal trafficking in opioids started with a prescription pad. Now, illegally manufactured street drugs have overtaken prescriptions as the primary driver of opioid abuse.
So why am I mentioning this? After all, emergency physicians don’t deal illegal street drugs; we prescribe opioids for acute pain. I mention this because of this statistic from the National Institute for Drug Abuse: 80 percent of current heroin users say their first opiate was a prescription drug.
Of course, this doesn’t mean we can—or should—stop prescribing opioids altogether. But I believe strongly that we need to renew our focus on responsible prescribing. I, myself, have resolved to prescribe less and for shorter periods, and I know many of you have done the same. I know it’s not always easy, but I urge you to keep up the good work.
It’s easy to become desensitized—even numb—to the opioid crisis. The constant struggle with drug-seeking patients is exhausting. The day-in, day-out toll of human misery is demoralizing. Laws that tell us how to prescribe are frustrating. I know I have been guilty of tuning it all out.
But as physicians, we are in a unique position to help end the crisis. A couple weeks ago, U.S. Surgeon General Dr. Vivek Murthy sent a letter to every physician in the United States asking for our assistance in tackling the opioid epidemic. If you haven’t already, I urge you to read the letter, take the pledge, and check out the resources on alternative treatment options and responsible opioid prescribing.
I’m also happy to report Ohio ACEP is working on a program to fight opiate addiction. Led by our own Dr. Ryan Squier, the “NIX Opiates” campaign will bring emergency physicians to Ohio high schools to share their up-close perspective on opioids, addiction, and overdose. We will have much more to report in the October eNews. Be on the lookout for an article with details on NIX Opiates and how you can get involved.
Talk to your colleagues, your groups, and your hospitals about reducing opioid prescriptions. Prescribing less and saying “no” more isn’t easy—doing the right thing rarely is—but if we keep it up and support one another, we can make a huge difference in reversing the epidemic.
Michael
Michael J. McCrea, MD, FACEP
President, Ohio ACEP