Opioid epidemic continues in wrong direction, doc tells Montevideo crowd
MONTEVIDEO — Chris Johnson began working on this country's opioid epidemic long before it became front page news, all because of what he saw as a medical doctor in Minnesota.
"Despair," he said of its toll on the addicted and their families. He addressed a room full of health care providers Wednesday evening at the Chippewa County - Montevideo Hospital.
Johnson is among those in the medical community calling for change to stop the epidemic. He serves on the board of directors for the Steve Rummler Hope Foundation and on the Physicians for Responsible Opioid Prescribing, both of which raise awareness about the epidemic and what can be done to stop it.
"It's not going in the right direction," Johnson told the Tribune. "You can see why. Nothing about the fundamental delivery of healthcare and medicine has changed. Nothing."
During the years 2000 to 2014, over 189,000 people died of overdoses linked to prescribed opiates in the U.S. That's more than the number of U.S. soldiers who died in World War II, he said.
The U.S. represents 5 percent of the world population, and consumes 80 percent of all opioid pain relievers. Americans consume 99 percent of the world's hydrocodone. In 2010, doctors prescribed enough opioids to medicate everyone in the U.S. for an entire month.
"It has not always been like this," Johnson said. Prescriptions for opioids rose from 76 million in 1991 to over 230 million today.
Johnson said he supports the use of opioids to treat pain resulting from injuries and cancers, where there is a known exit point.
He lays the blame for the epidemic on a variety of factors, from industry greed to a medical system that is vulnerable to manipulation.
"None of you should leave tonight thinking this was just an accident," Johnson said to the providers Wednesday.
He said the pharmaceutical industry aggressively marketed opioids to primary care physicians to expand their use beyond care for those with cancers or acute injuries. The industry blurred the line between academic societies, patient advocacy groups and marketing to promote their use, he said.
Johnson described how the industry encouraged leaders from academic fields to call for addressing what was termed the "chronic pain epidemic." No such epidemic exists, he said.
Joint and back pain and many other types of pain not related to acute injury have always been widespread. "That's life, that's not an epidemic," he said.
"Pain is the fifth vital sign" became a popular mantra and the pharmaceutical industry claimed that opioids could "give people their lives back." Yet scientific data on disabilities offer no evidence that prescribing opioids has given anyone their life back. The number of people receiving Social Security disability payments has jumped 2,000 percent since doctors began prescribing opioids for chronic pain, he said.
Johnson said Americans have been misled too by a much publicized and debunked claim that opiates carry less than a 1 percent risk of addiction. The claim was based on a 1980 case in which 12,000 people had been treated for acute injuries, and removed from opiates after a short period. It is the equivalent of giving someone four cigarettes and no more, and then claiming afterward that tobacco is not addictive, he said.
Prescribing opioids remains the "path of least resistance" for doctors and medical centers to reach customer satisfaction goals. Medicaid and Medicare mandate patient satisfaction surveys, and reimbursement rates are dependent on favorable responses in them, according to Johnson.
The federal government has now pledged to remove questions about pain medications from those surveys, Johnson said. He remains concerned, nonetheless. A 2010 study showed a clear improvement in customer satisfaction scores when pain medications were prescribed. Medical facilities dependent on favorable scores for reimbursements have every incentive to continue prescribing them, he said.
Health care providers also labor under the requirement of asking patients to rate their pain level on a 1 to 10 scale. An assessment so obviously based on emotion should never be considered a reliable metric, he said.
He also questions the ability of the Food and Drug Administration to objectively perform its work when half of its budget is based on fees from the pharmaceutical industry.
Johnson spoke this week at the bequest of Shelly Elkington, owner of Avenues for Care in Montevideo. A registered nurse, she also serves on the Steve Rummler Hope Foundation board of directors.
Elkington said she got a "reality check on the opioid epidemic'' in August 2015 with the death of her daughter Casey. She had become addicted to opioids after being prescribed and using them for about 2½ to 3 years for a chronic pain condition. Casey was 26 years old at the time of her death.