Chronic Pain and Addiction Patients Need Us Now More Than Ever

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Author: Shane A. Sobrio, MD
Originally published: Common Sense
March/April 2021

Flashback to 2019. Hong Kong protests were raging on, the U.S. Women’s National Team won the world cup, Donald Trump was being impeached, and the health care battle continued to revolve around the opioid epidemic. It wasn’t necessarily easy, but it was familiar. Practices were being implemented to help prevent reckless opioid prescribing and increase availability of naloxone which, to an extent, were working. Flash forward to 2020, the year of the COVID-19 pandemic. Millions of people worldwide now dead from a novel respiratory virus and opioids are a distant memory, no longer causing the problems they used to, right? Unfortunately, not right at all.

In 2018, drug overdose deaths dropped for the first time in 20 years. Nearly 47,000 people still died of opioid overdoses in the United States in 2018, but the slight down trending from the previous year began to create some level of optimism regarding the epidemic and its’ future. To put it lightly, 2020 has been a step in the wrong direction. People are losing their jobs, their social interactions, and their support systems. It is not surprising that tragedies such as overdoses, and suicides are up. Additionally, for patients with chronic pain, “elective” pain management procedures have been delayed or indefinitely cancelled, further exacerbating the suffering.

While the COVID-19 pandemic is rightfully garnering most of our current attention due to the rapid spread and deadliness of the virus, data would suggest our diligence to the opioid epidemic has waned, creating a significant number of secondary COVID-19 casualties. A study published in JAMA in September 2020 showed that urine drug screens for opioids such as fentanyl and heroin nearly doubled in the first few months of the pandemic.1 While official 2020 drug overdose data is not yet published by the CDC, some early data suggested a 13% increase in drug overdose deaths during the pandemic, which translates to many thousands of lives.

It is sometimes easy to forget that statistics represent human beings. People with loved ones, dreams, aspirations, etc. Unfortunately, when it comes to opioids and overdose deaths, those numbers have often been my family and friends. In fact, in 2019, one of those numbers was my older brother, who died at just 31 years old from an accidental overdose. He was the 4th family member or friend to pass at a young age from something similar. I can no longer afford to think of these statistics as numbers and must start finding ways to turn these tragedies into solutions.

While the outlook may seem grim in some ways, there are certain reasons to be optimistic. Availability of lifesaving naloxone is at an all-time high. Awareness of the epidemic itself has been steadily increasing over the past few years as well. Most importantly, the opioid epidemic and the response needed to fight it adequately have garnered more congressional bipartisan support than almost any other political issue of our time.

As emergency physicians, we have a difficult but privileged position in our society. We often see people at their lowest of low points. We give them naloxone during an overdose, we intervene when they are suicidal, and sometimes we simply provide an ear to listen when someone needs to be heard. I am as guilty as anyone when it comes to feeling frustrated after getting assigned another psychiatric patient or drug-seeking patient in the ER. However, I am using this worldwide disaster as an opportunity to address my biases and think about how I am contributing to the solutions instead of adding to the problem. I implore everyone reading this to spend that extra five minutes listening, provide that extra advice or encouragement; make that extra phone call. With emergency physicians leading the way, we will get through this opioid epidemic (and COVID-19 pandemic) together.