As a member of Congress, I will join the House Opioid Task Force whose objectives are to educate Congress and to lobby for funding. There are seventeen bills on their agenda, with five key provisions:
1. Providers applying for Drug Enforcement Administration (DEA) licenses must certify that their prescriptions will conform to the highest standards. This means, among other things that, as a first step, providers will prescribe non-opioid analgesics, and they will limit prescriptions to a 10-day supply.
I would go further: I would recommend that patients upon discharge from hospitals not be prescribed opioids if they had not required them one day prior to their discharge. I would further limit prescriptions to a 3-day supply: most pain from surgery resolves substantially within a week.
Because pain is an indicator that something is wrong, taking opioids unnecessarily risks overlooking an underlying problem. In addition, there is a considerable psychological component to pain that arises from fear. We must address that issue by educating patients more fully and attentively about what to expect after surgery. Often, because we encourage patients to believe they will be free of pain after an operation when they experience pain they grow fearful. Engaging patients in their healing process is fundamental. Ancillary non-medical therapies such as massage and meditation have been proven to reduce the perception of pain. One example of this is the widespread practice of natural childbirth. These same principles can be applied to other areas of pain management.
Over the past three decades the emergence of “pain clinics” has undoubtedly contributed to this epidemic. The profits from these clinics are an example of what happens when the profit motive is privileged, and when so-called “regulations” are criticized and condemned as inappropriate Government interference. The role of Government is to protect the populace. We need educated scientists in Congress to address these issues.
2. Addiction management courses for physicians.
I would go further: In my view, the public should also be fully educated about the extreme vulnerability we all have in the treatment of pain and anxiety.
3. Prescriptions for controlled substances received through Medicare part D should be transmitted electronically.
I would go further: I would require that all prescriptions be electronically transmitted, not just those received through Medicare Part D, and that all prescriptions be made available to all pharmacies nationwide to facilitate the discovery of pharmacy hopping.
4. Expanding access to medication-assisted treatment by broadening prescriber eligibility.
Currently, there are several medications that can assist the transition from dependence on opioids. However, these medications have their own propensity for addiction. They can be used to alleviate the initial symptoms of opioid withdrawal but must be administered by trained providers, whether they be physicians, nurse practitioners, or registered nurses. A multi-faceted approach to psychological, familial, and community support is required in addition to medication.
5. Finally, there is this: The INTERDICT Act. This bill will supply US Customs and Border Protection with chemical screening tools to help prevent fentanyl and synthetic opioids from entering the country.
I support this bill. But good medicine in disease management must involve addressing the underlying causes of the illness. These are invariably multifactorial. Although we are all eager to find a quick fix for this tragedy we should consider the combination of regulation and “hard science” to find a solution. I propose we have educated people in Congress who can evaluate the science objectively free of the influence of either the pharmaceutical industry or the now burgeoning marijuana industry.
There are certain principles in medicine that hold true across all diseases and systems: an important one is prevention. Again, that requires an investigation into underlying causes. I believe a first step is to destigmatize addiction so families can help their loved ones get treatment early in the course of the disease. I also believe that as a society we should consider the economic and social stresses our young people experience when they see actions and behaviors in our leaders that are contrary to a culture of caring.
If, as in the 1960’s, our leaders are driven by fear, greed, and anger rather than by courage, compassion, and hope we will lose our most precious resource: our children. Let’s bring science and sanity back to Government.