Time. Money cannot buy it. All things require it. Nothing can stop the flow of it, and time once past cannot be brought back. There are countless sayings about time: “there is no time like the present,” “you’re running out of time,” “not enough hours in the day,” “time and time again.” Time is invaluable for many reasons. It is as delicate as it is misunderstood. Not taking enough time can be as destructive as procrastination. When you boil it down, everything is about time.
Time and the Opioid Epidemic
It’s interesting to note how time, and timing, have impacted the opioid epidemic. When OxyContin made its debut on the market in 1996, Purdue Pharma had only been testing it as a long-term painkiller for two years. The company launched their 1998 video promotion “I Got My Life Back”, distributing 15,000 copies to be used in physician waiting rooms as a ‘check out’ item for an office’s patient education library.” A year later, the overall number of opioid prescriptions filled increased by 11 million. Today, it takes an average of 12 years for an experimental drug to proceed from preclinical testing to the market. That is, if the drug even makes it to market. If the FDA had taken the time to truly study the addictive qualities of OxyContin, it never would have been marketed the way it was.
Even the best tools are rendered useless if not given time for proper implementation. The development of Prescription Drug Monitoring Programs (“PDMPs”) arose as a response to growing concerns regarding drug abuse and drug-related deaths. PDMP electronic databases were designed to collect data on substances dispensed within a given state. On a micro-level, PDMPs can be used at the individual-patient level to identify Doctor Shoppers so that prescribers can be proactively alerted. On a macro level, PDMP records can be utilized to identify Pill Mills, as well as insurance fraud billing for certain drugs and drug diversion within a locale.
While good in theory, PDMPs are less effective in practice. Many prescribers are not taking the time to register with PDMPs, let alone use them as a resource during patient evaluations. These things take time, something busy healthcare practices don’t have. Not having enough time to properly conduct new patient evaluations is a catalyst for mistakes that we cannot afford to overlook.
It’s not just about time, it’s also about timing. After seven years of repeal-and-replace rhetoric against the Affordable Care Act, Republicans finally passed the American Health Care Act of 2017 (H.R. 1628) (“AHCA”), repealing the Patient Protection and Affordable Care Act (ACA). The party had seven years to get the bill ready, but they let time slip by. Unfortunately, we are now in a healthcare crisis directly impacting the opioid epidemic due to various cuts being made to Medicaid and addiction treatment. No one intended for this to happen. It is a consequence of procrastination coupled with poor time management.
In the wake of our current epidemic, dependent opioid users who truly need opioids to perform day-to-day functions (such as chronic pain patients) have been caught in the crossfire as physicians and policymakers attempt to eliminate opioids altogether. The stigma associated with opioids is that all users are addicts, but that is not the case. There is a difference between opioid addiction and opioid dependence.
The new January 1, 2017 CDC Guideline for Prescribing Opioids for Chronic pain set the recommended dose of a morphine equivalent for chronic pain patients to no more than 90 mgs, unless the individual has been given less than six months to live. That is one dose to many patients. If the new administration has its way, insurance companies will stop covering anything over the recommended 90 mgs dose, forcing patients to pay out-of-pocket for anything exceeding that amount, with an added caveat that the DEA will be advised of any patient paying cash for an opioid script. Sadly, we know where that road leads…to the local heroin dealer who has a product both stronger and cheaper until suddenly the patient is no longer a dependent, they are addicted.
As I’m sure Dr. Sarah Wakeman, M.D., Medical Director of Mass General’s Substance Use Disorders Initiative (SUDs) will agree, there is no “one-size-fits-all” solution to the opioid epidemic. Rolling out a blanket anti-opioid campaign is not the answer. It’s time to tackle these issues on a case-by-case basis while also exercising compassion for legitimate, opioid dependent users.
A Stitch In Time Saves Nine
For an opioid addict, time is always about the next high and every high is a countdown to the next fix. Time will never be on the side of addiction, which is why time is truly of the essence. As the old proverb states, “A stitch in time saves nine.” In most cases, the proverbial “stitch” refers to preparatory work to make things easier down the road. When it comes to addiction, I believe the “stitch fix” lies in waiting.
A “waiting period” is the period of time between when an action is requested and when it occurs. Many things are subject to them- from insurance policies and IPOs, to the purchase of firearms as well as abortion and/or divorce in certain states. Laws imposing waiting periods were created to reduce risk. Firearm waiting periods were developed so that ample time could be allotted to perform a background check as well as to provide a “cooling off” period to guard against impulsive acts of violence.
Although different in nature, both firearms and opioids pose a threat. In the same way that NCIC waiting periods have worked to avert gun violence, initiating a 72-hour waiting period prior to a doctor releasing a patient’s first opioid prescription would be a step in the right direction to preventing drug abuse and drug-related deaths. Both waiting periods will work to save lives.
An Ounce Of Prevention Is Worth A Pound Of Cure
As the famous Benjamin Franklin axiom states, “an ounce of prevention is worth a pound of cure”. In other words, it is easier to prevent something from happening than to repair damage afterwards.
We can never go back. Life is a ONE-TIME offer, and we cannot afford not to make time for what matters. It’s time to be proactive about drug diversion and addiction. Don’t put your professional license or the lives of those around you at risk because you neglected to make time for a drug diversion assessment. TITAN offers a full suite of drug diversion services designed to equip companies and their staff with the necessary tools to stop the diversion of controlled substances BEFORE it happens. Contact us today to learn more.
I must make a disclaimer: I have been using drugs, buying drugs, investigating drugs, studying drugs for the past 32 years. I am a self-professed expert in all things drugs. 26 years with the DEA, combined with personal experience taking pain pills for a bad back gives me a perspective that is quite unique. Nothing in books or on TV can prepare one to deal with the devastating issues that surround drug addiction. TITAN’s mission is to educate not only doctors and pharmacists, but the other side as well, in hopes that together we can end the story of opioid addiction once and for all.