Many problems among developed countries are unique to the United States. Gun violence is at levels comparable to locations of civil unrest around the world, and we are proud of our world leadership in obesity. Our dysfunctional healthcare incentives and payment system, despite many examples of innovative excellence, shows starkly different health status based on socioeconomic standing.
Opioid abuse and overdose is a rapidly increasing issue in the United States. Even more damning is the obvious: all the opioids in circulation are at some point prescribed by physicians. There are no fingers to be pointed except at ourselves. Opioid abuse has given rise to increased heroin use and sporadic clusters of deaths, as unfortunate addicts find their typical supplies laced with fentanyl or acetyl-fentanyl, each far more potent concoctions. Naloxone auto-injectors have recently gained notoriety – but, while these are life-saving in the appropriate circumstances, the devices cost several hundred dollars and address the symptoms of the epidemic, not the root causes.
The Academic Life in Emergency Medicine recently hosted an excellent Google Hangout discussing the challenges associated with opioid prescribing – balancing the alleviation of suffering with downstream diversion and other complications. Resident authors from the Harvard-Affiliated Emergency Medicine Residency were joined by clinical toxicologists from Toronto and Washington, D.C., to discuss appropriate analgesia in the Emergency Department. Surprisingly, many resident respondents felt this aspect of practice was highly neglected in their training. The video discussion, the comments section, and the accompanying Twitter feed highlight questions and responses from all levels of training and expertise.
One of the other interesting question posed, however, was – how are prevalent are opioid prescribing and abuse issues outside the U.S.? Are you evaluated on patient satisfaction – and pressured to give opiates as a result? Are prescription databases widely available to screen patients at risk for abuse or diversion? How was your analgesic education handled?